THE PHILIPPINE Health Insurance Corp. (PhilHealth) will undergo a “major revamp” to improve its efficiency and address operational challenges, the Governance Commission for Government-Owned or -Controlled Corporations (GCG) said.
The GCG approved the restructuring of PhilHealth at its en banc meeting held on June 25 (Wednesday), it said in a statement.
“The restructuring includes a revamped organizational structure with 503 units and a total of 7,149 positions designed to improve service delivery and strengthen the agency’s capability to fulfill its expanded mandate under the Republic Act No. 11223 or the Universal Health Care Act,” it said.
“The reform aims to address several long-standing issues including outdated workforce, fragmented data and strategy execution, and issues related to benefit claims.”
The GCG said part of the restructuring will involve the centralization of five critical services of the state health insurer: finance, legal, information technology, procurement, human resources, and general administration services.
“The centralization of these administrative functions is seen to address the inconsistencies and conflicts in the current operational framework of PhilHealth, maintain responsiveness to the public, and enhance healthcare delivery.”
PhilHealth was also ordered to strengthen its internal audit office. “To foster independence and ensure checks and balances, the internal audit office shall functionally report to the Audit Committee of the Board of Directors and shall administratively report to the president and chief executive officer of the corporation.”
The creation of units like the Benefit Payment Appeals Office (BPAO) is also part of the revamp. The BPAO aims to improve the processing of appeals cases.
PhilHealth has one year to implement the services and centralization outlined in the GCG’s order and is required to submit quarterly reports to allow the GCG to monitor its progress.
The state health insurer booked a net loss of P192.96 billion in 2024, narrower than the P708.72-billion loss it posted in 2023, its latest financial statement showed. Its retained earnings stood at P149.58 billion at end-2024, while its reserve fund was at P280.57 billion.
PhilHealth Senior Vice-President Renato L. Limsiaco, Jr. told Congress in January that the state health insurer owed hospitals about P21 billion as of end-2024.
The Supreme Court last year issued a temporary restraining order, halting the transfer of P29.9 billion from PhilHealth to the National Government after the initial transfer of P60 billion. The case is still pending resolution. — ARAI
