The Philippine Health Insurance Corporation (PhilHealth) announced its release of over P217.93 B in total benefit claims to healthcare facilities nationwide which represents a 94.18% increase compared to the same period last year (January to September).
This surge in payments solidifies PhilHealth’s financial support and marks a major achievement in its drive to provide prompt and reliable financial support to Filipino patients and healthcare providers.
PhilHealth’s total claims payment for the first nine months of 2025 reached P217.93 Bn, up from P112.23 B in 2024, both for public and private facilities.
Private facilities received P127.79 B, while public facilities accounted for PHP90.14billion in reimbursements.
As of September 30, 2025, PhilHealth achieved an average claims processing turnaround time
of just 22 days, demonstrating remarkable improvement in efficiency and responsiveness, aligning with President Ferdinand R. Marcos’ directive to improve its performance.
PhilHealth emphasized that the expenditure is largely driven by payments for catastrophic conditions covered by Z Benefit Packages (heart surgery, cancers and kidney transplantation) and high-cost services like outpatient hemodialysis continue to rise significantly, reflecting the increasing medical needs of the population. This commitment ensures that members diagnosed with life-threatening or complex illnesses receive sustained, high-value financial support.
To ensure PhilHealth’s payment system sufficiently covers the complexities of modern medical treatment, the Corporation reiterated the need to transition Diagnosis-Related Group (DRG) payment system.
According to Dr. Edwin M. Mercado, PhilHealth President and CEO, PhilHealth is actively pushing for a shift to DRG payment system. “DRG will better account for the severity and resources needed for patient care, thereby ensuring that our healthcare providers are compensated accurately and sustainably for treating complex conditions.”, said Dr. Mercado.
DRG is a patient classification and provider payment system that groups patient cases, including services received, into standardized case groups according to diagnosis and treatment or procedure received.
PhilHealth assures the public that it will continue to accelerate its claims process through streamlined and automated systems to sustain the fast flow of funds to accredited healthcare facilities, adhering to its commitment of being Mabilis, Tapat, and Mapagkakatiwalaan. (PhilHealth)
