De Lima Advocates for Inquiry into PhilHealth's Unpaid Hospital Claims

In a call for accountability, Representative Leila de Lima of the Mamamayang Liberal (ML) Party-list has proposed a congressional investigation into the Philippine Health Insurance Corporation's (PhilHealth) ongoing issue of unpaid hospital claims. This initiative comes as several private hospitals have recently ceased honoring guarantee letters related to the Medical Assistance for Indigent and Financially Incapacitated Patients (MAIFIP) program, which has left many patients in precarious situations regarding their healthcare costs.

The proposal, encapsulated in House Resolution 46, aims to address the mounting grievances from private hospitals. According to the Private Hospitals Association of the Philippines Inc. (PHAPI), 43 hospitals in Batangas alone are owed over PHP 530 million in claims, with some facilities facing receivables as high as PHP 94 million. De Lima emphasized the urgency of the situation, stating, "This has been a perennial issue that should urgently be addressed once and for all. It burdens patients and their families with additional fear if they could get assistance from the government in medical expenses."

The implications of unpaid claims extend beyond mere financial transactions; they affect the stability of healthcare institutions. Hospitals are experiencing financial strain, which threatens their ability to maintain operations and pay healthcare professionals. As De Lima articulated, "These unpaid debts affect hospitals' financial stability and operating expenses, including salaries for healthcare professionals and staff. This situation is already alarming because how can we implement the Universal Health Care Law if this problem is yet to be addressed?"

De Lima's inquiry seeks to scrutinize existing government policies that govern hospital payments and identify gaps that lead to delays. The resolution urges the government to establish clear mechanisms for settling unpaid claims to ensure that hospitals can continue providing essential healthcare services without interruption.

The 2025 national budget has raised concerns as it allocated zero funding for government subsidies to PhilHealth, attributing this lack of support to the agency's inability to effectively utilize its existing budget. In contrast, the MAIFIP, which is designed to assist indigent Filipinos with healthcare costs, has received a budget allocation of PHP 41.15 billion for the upcoming year.

Experts argue that this financial disarray not only undermines the healthcare system but also poses a significant risk to public health. Dr. Maria Santos, a health policy expert at the University of the Philippines, noted, "The inability to settle hospital claims jeopardizes the trust between healthcare providers and patients, which is critical for the effective implementation of health programs in the country."

The potential consequences of this unresolved issue extend beyond immediate financial concerns. If left unaddressed, the ongoing disputes may lead to a significant decline in healthcare quality and accessibility, particularly for economically disadvantaged populations who rely on government assistance for medical care. De Lima's call for an investigation reflects a broader concern about the sustainability of healthcare in the Philippines amid rising costs and insufficient government support.

As the congressional inquiry unfolds, stakeholders from various sectors, including healthcare professionals, government officials, and patient advocacy groups, are expected to contribute their insights and solutions. The outcome of this investigation may shape the future of healthcare funding and access in the Philippines, making its significance paramount for the nation's health infrastructure.