PhilHealth to expand primary care, ‘No Balance Billing’ under DOH-aligned framework

NEW PHILHEALTH CHIEF. President Ferdinand R. Marcos Jr. facilitates the oath-taking of Dr. Beverly Ho as the new PhilHealth President and Chief Executive Officer on Aug.11, 2026. Ho replaced Dr. Edwin Mercado, who was appointed as new Department of Health secretary. (Photo courtesy: Office of the President)

By Ma. Teresa Montemayor | Philippine News Agency

The Philippine Health Insurance Corporation (PhilHealth) is committed to accelerating primary care expansion and reinforcing financial protection through the No Balance Billing (NBB) policy nationwide under a unified strategic format with the Department of Health (DOH).

In a press briefing on Thursday, newly installed PhilHealth President and Chief Executive Officer Dr. Beverly Ho said the shared mandate, Unified National Agenda (UNA), aims at improving health outcomes, scaling up access sites, and broadening benefit packages for all Filipinos.

“Our job now is to ensure that we continue to progress by increasing access points, improving benefit packages, and ensuring that every member receives quality care,” she said.

“(We will) build on previous gains rather than start from scratch. Focus on better execution and systematically addressing feedback and challenges to reduce friction and improve access for members, physicians, and providers,” she added.

When asked about the state insurer’s priorities under her watch, Dr. Ho disclosed a five-pillar shared agenda with the DOH. These include:

  • Bringing primary care to schools and workplaces;
  • Strengthening and integrating public health programs into primary care;
  • Expanding NBB to reduce hospital cost fears;
  • Cutting red tape by streamlining DOH and PhilHealth processes via a unified IT system; and
  • Organizational strengthening through smooth reorganization and empowering health workers with fair compensation and greater responsibilities.

For the benefit package for children with developmental disabilities, Dr. Ho said PhilHealth is enhancing the package and increasing therapy sessions.

The implementation is anticipated within the year as the state insurer revalidates with healthcare professionals the original costing from 2017 to ensure rates are adequate.

She added that PhilHealth is collaborating with the Department of Education and the Department of Social Welfare and Development to streamline referral pathways and facilitate therapy sessions in select schools.

To improve public access to essential medicines, Ho said 21 medicines currently under YAKAP (Yaman ng Kalusugan Program) will be transferred to the GAMOT (Guaranteed and Accessible Medications for Outpatient Treatment) program.

This move will integrate the medicines into the annual P20,000 benefit under GAMOT program.

Addressing concerns regarding value for paying contributors, Dr. Ho underscored the need to prevent benefit increases from triggering price inflation in healthcare facilities.

She said that PhilHealth will work closely with medical providers to ensure members experience tangible value from their contributions, fostering consistent participation across the board.

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