FIRST, OUR state health insurance (PhilHealth). Under the Universal Health Care (UHC) Act (Republic Act No. 11223), ideally, 100% of the Filipino population is automatically entitled to national health insurance.
I say “ideally” because a 2025 survey by the Philippine Statistics Authority’s National Demographic and Health Survey found that 69.7% of households are actively covered by PhilHealth or identify as members of the state health insurance. However, it also noted that 29.7% of households reported lacking awareness of or coverage by any medical safety net during data collection.
That is unfortunate.
When 30% of Filipino households have not heard of the UHC Act, it highlights a gap in the government’s information advocacy or communication plan. PhilHealth, in tandem with local government units, must aggressively inform far-flung communities about the benefits of the law, notwithstanding PhilHealth’s report that its recorded beneficiaries had reached 106.24 million individuals by 2025.
Information dissemination should not stop at office premises or social media posts that rarely reach off-grid communities. If state insurance promises universal safety, then strategic grassroots education campaigns must be implemented – regardless of geography – to help people understand how to exercise their legal right to health coverage.
Moving forward.
Outside of the UHC Act, I am a believer in private health insurance, influenced by my work in the corporate world. In the Philippines, a Health Maintenance Organization (HMO) is a private company that provides health insurance coverage through a specific network of accredited doctors, clinics, and hospitals.
In a present-day reality where wellness can change in an instant, having a reasonably-affordable health policy is not just a monthly premium – although, in my research this week, the eligible age of sixty years and five months requires an annual premium. That means paying a single lump sum! It’s tougher on the pocket, er, the wallet.
Still, private health insurance serves as both a financial shield and a gateway to quality medical care. Since 2013, my health insurance has served me quite well, except for the hiccups that routinely happen along the way. Nevertheless, you must live with it. You adapt to the inconveniences because it is the easier option.
The most immediate benefit of private health insurance is the financial protection it provides against astronomical hospital costs. Medical and non-medical emergencies create a hole in your finances. A single complex surgery or a prolonged hospital stay can easily deplete years of hard-earned savings.
HMOs minimize that financial blow, ensuring the insurance company absorbs the brunt of distressing medical bills. Although my policy does not feature cashless hospitalization – I can only wish – I still feel a reasonable sense of relief whenever I am confined, knowing I have help on the side.
Moreover, private health insurance changes how you interact with the healthcare system. Uninsured individuals often delay seeking medical attention due to the cost involved. I have often heard this justification spoken in conversations.
With my HMO, I have been able to seek semi-annual checkups since 2015. Mostly, regular availment has been hassle-free. It’s usually during hospital confinements that I encounter frustrations, but I’ve survived those upsets so far.
And now the crux of the matter: Is private health insurance affordable to Juan and Juana?
I’m afraid not.
According to data compiled by Capstone-Intel Corp., only roughly 35% of Filipinos have access to private health insurance or HMOs. See, that’s only 35% of our total population. Let that sink in.
Hence, we must address this glaring gap in accessibility. If private coverage is essential in our healthcare landscape, in addition to state insurance (PhilHealth), it should not remain a luxury reserved for a few. When sixty-five percent of the country is left without a private safety net, any sudden, major illness becomes an immediate financial catastrophe for the Filipino family.
This is where the health insurance industry can revolutionize. The industry must innovate, think creatively, and make private health insurance affordable for the average working family by introducing more flexible payment tiers, micro-insurance options, or public-private partnerships that can bridge the divide. That’s right, make it easy on the working-class Filipino.
Until quality coverage becomes financially reachable for the everyday household, true peace of mind will remain a privilege for our country.
And that’s not inclusive at all.
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The author owns and manages Belinda Communications Consulting. You can reach us via email at belca.87@gmail.com. Engage with us on X @ShilohRuthie./PN
