PhilHealth counting on ‘substantial’ receivables from PCSO, PAGCOR

THE Philippine Health Insurance Corp. (PhilHealth) said on Wednesday it is counting on expected funding from government gaming and charity agencies to expand its primary care services.

Edwin M. Mercado, president and chief executive officer said the Philippine Amusement and Gaming Corp. (PAGCOR) and the Philippine Charity Sweepstakes Office (PCSO) will provide “substantial” funding to expand benefits.

“This extra funding from PAGCOR (and) the PCSO is meant to expand the benefit coverage of which the primary care is definitely going to be part of. So that is what we are waiting for,” he said during a roundtable.

Mr. Mercado said programs to be funded include the Yaman ng Kalusugan Program para Malayo sa Sakit (YAKAP), which needs about P34 billion for 2026.

“From the time the (Universal Health Care Act) took effect in 2019 up to 2025, the receivables have reached around P106 billion,” he added.

Under UHC, 50% of the National Government’s share of PAGCOR income and 40% of the PCSO’s proceeds, net of documentary stamp tax payments and mandatory contributions, must be transferred to PhilHealth.

PhilHealth said there are currently 36 million Filipinos registered for YAKAP, an enhanced primary care benefit package covering consultations, indicated laboratory and cancer screening tests, and prescribed essential medicines.

PhilHealth is also looking to roll out its Guaranteed and Accessible Medications for Outpatient Treatment (GAMOT) program outside the National Capital Region within the end of this year. PhilHealth aims to reach other provinces by this year or 2026, reaching phase 4 of the rollout.

Mr. Mercado said 304 pharmacies accredited nationwide for the GAMOT program as of Sept. 30.

“Our target for the total registered this year is 50 million and our target for the total first patient encounters is 20 million (this year),” he said.

PhilHealth Vice-President Walter B. Bacareza said the health insurer is accelerating the payments of hospital receivables.

“I am very happy to say that PhilHealth is now paying at a turnaround time of 23 days. We have even regions that are paying in 10 days, 13 days,” he said.

Mr. Bacareza said the previously reported P59 billion in receivables owed to hospitals were denied due to lapse of the 60-day filing period, but more flexible treatment of claims has brought the total down to P10 billion. — Aubrey Rose A. Inosante