PhilHealth: Few Filipinos availing themselves of Konsulta
“They’re already discounted because I am a senior citizen,” the 61-year-old widow said.
She presented a prescription to the drugstore to buy her month’s supply of losartan, a maintenance drug for hypertension, as well as other supplements.
Trips to the pharmacy are monthly, while lab tests need to be repeated at least twice a year.
Garan depends on her measly P2,500 monthly pension as well as occasional money from her children for her health expenses.
Sometimes, if she’s lucky, there are free checkups and medicines provided by the barangay.
In a year, she has to spend P10,000, which she said is too heavy a burden.
“That amount of money can be used to buy food for our extended family and to pay for our utilities,” she said.
READ: Zero PhilHealth subsidy will affect Konsulta package – doctor
Crucial program
The problem is that the government is supposed to provide these routine checkups and maintenance medicines for free, or these should be heavily subsidized at the very least under Republic Act No. 11223, or the Universal Health Care Act of 2019.
Garan is among the majority of the Filipino population not benefiting from the Konsulta outpatient benefit package of the Philippine Health Insurance Corp. (PhilHealth).
Since 2020, PhilHealth has been offering this benefit for outpatient services, similar to when a patient uses private health insurance provided by health maintenance organizations (HMOs) to seek consultation from doctors without the need to be confined in hospitals.
Konsulta provides eligible members with comprehensive outpatient primary care, including consultations, health risk screenings, and selected lab tests and medicines—all free of charge at their chosen accredited health-care facility.
During his first press briefing as PhilHealth president and CEO, Dr. Edwin Mercado touted Konsulta as a crucial program in realizing universal health care in the country.
However, he admitted that very few Filipinos were availing themselves of the Konsulta package, mainly due to low awareness about it and the limited number of accredited facilities providing the service.
Under RA 11223, all Filipinos are automatically enrolled as PhilHealth members, but not all PhilHealth members are immediately enrolled in Konsulta, as it requires registration with their preferred providers.
Based on PhilHealth data, only one in 20 Filipinos might have used the Konsulta program last year.
Out of the 112.88 million population in 2024, 90 percent or 102.75 million are registered as PhilHealth members, but only 27.8 million or 24.6 percent are registered with Konsulta providers.
Worse, only 6.37 million (5.6 percent) had a “first-patient encounter,” wherein a primary care provider took or updated the basic health data of an eligible beneficiary. This did not mean that the member had a consultation with a doctor.
Health advocates estimate that merely “1 percent” of the population had really availed themselves of Konsulta benefits in 2024.
LGU help
While PhilHealth performs its mandate to expand free health services, Mercado is encouraging local government units (LGUs) to help in disseminating information to their constituents about the Konsulta package.
According to PhilHealth data, 88 percent of the 1,642 cities and municipalities in the country already have an accredited Konsulta provider, but relatively few LGUs are “very aggressive” in helping their people to get registered.
The PhilHealth president also urged private health-care firms to get their clinics and hospitals to become accredited Konsulta facilities.
“Even if we are providing many benefits under the Konsulta program, if the Filipinos do not have access to them because there are only a few hospitals and facilities that are accredited to offer them, then the program will not succeed,” Mercado said.
“We need a full [national] approach to address this. Our responsibility at PhilHealth is to expand our benefit packages, but health-care providers also need to join us. This is the only way that we can help Filipinos in lowering their out-of-pocket health-related expenses,” he said.
There are only 3,149 accredited Konsulta provider institutions (2,661 government and 488 private) in the country, or only a quarter of the 12,765 PhilHealth-accredited facilities.
According to Mercado, private facilities were reluctant to get accredited “due to fear of not being paid on time.”
“So when I talked to them, I gave an assurance that we will expedite their payments and we will be fair in paying for their services,” he said, adding that they were also studying to increase the current P1,700 capitation rate per patient, or the fixed amount PhilHealth pays a provider annually.
Unlike inpatient benefit packages, where hospitals are reimbursed after the discharge of a patient, Konsulta providers receive a fixed sum per patient, paid in advance, depending on the number of registered members with the first patient encounter.
Last year, PhilHealth paid P3.59 billion for Konsulta claims—89 percent of which were at government facilities—or a mere 2 percent of the P164 billion in claims paid by the insurer in 2024, with the bulk for patients admitted in hospitals.
Expanded benefits
According to PhilHealth spokesperson Dr. Israel Francis Pargas, the state health insurer aims to grow its Konsulta registrations to 50 million Filipinos this year.
He added that they were aiming to approve within the year the expansion of the free medicines provided under the package from the current 21 drugs to 53 to entice more Filipinos to register on Konsulta.
“We are also studying how to expand the covered diagnostic and laboratory tests from the current 15 being provided free of charge under Konsulta,” he added.
PhilHealth is also in talks with the Department of Health to register around 24 million students in the Konsulta package.
“We are studying how to expedite the enrollment of PhilHealth members to Konsulta. Right now, we are seeing students as low-hanging [fruit],” Mercado said.
Filipino youth should be the people who will benefit the most from Konsulta’s outpatient packages. We should be taking care of their health while they are still young,” he added.
