FOR THE LAST 14 years, Filipinos are under the impression that the so-called “zero-balance billing” policy that the government has been bragging covers all public hospitals.
The truth, however, is that it isn’t.
No less than Department of Health (DOH) Secretary Teodoro Herbosa admitted that the policy only applies to 80 of the 721 public hospitals across the archipelago.
In principle, the zero balance billing policy covers room and board charges; professional fees of doctors, nurses, and specialists; laboratory tests and imaging (e.g., X-ray, CT scan), under case rates; use of operating rooms and hospital equipment, and medicines and medical supplies available in the hospital.
Plus diagnostic tests, surgery, and antidotes which form part of the PhilHealth benefits.
‘Aside from the fact that not all public hospitals are compelled to apply the zero-billing policy, the program only covers “basic medical services,” which leaves patients suffering from serious ailments in limbo.’
PURELY P.R. STUNT
During his fourth State of the Nation Address (SONA), President Ferdinand Marcos Jr. announced that charges for basic accommodation and medical services at DOH-run hospitals are now fully covered — or simply zero balance billing upon discharge.
The President in his speech emphasized that patients are no longer required to pay out-of-pocket for eligible medical services, adding that the bills are already covered by the government.
In addition to existing Philippine Health Insurance Corporation (PhilHealth) benefits, the expanded coverage is made possible through the Medical Assistance to Indigent and Financially Incapacitated Patients (MAIFIP) program —in partnership with other agencies— and through direct allocations to DOH hospitals.
TERMINAL AILMENTS
However, full implementation of the zero billing policy (meaning the patient should not be made to pay a single centavo) doesn’t really exist as most DOH-run hospitals are facing challenges.
Aside from the fact that not all public hospitals are compelled to apply the zero-billing policy, the program only covers “basic medical services,” which leaves patients suffering from serious ailments in limbo.
Interestingly, the zero-billing policy does not cover specialty hospitals where terminal cases are usually brought. The list includes the National Kidney and Transplant Institute, Lung Center of the Philippines, Philippine Heart Center, and Philippine Children’s Medical Center, which are under the auspices of government-owned and controlled corporations (GOCCs).
FISCAL CONDITIONS
While “zero balance billing” literally translates to free, the policy may not necessarily be true amid persistent factors and circumstances.
Among the factors hampering an honest-to-goodness include hospitals running out of medicines or supplies for which patients are compelled to buy elsewhere.
There are also some procedures or medications which are not covered by PhilHealth. In most cases, patients are not aware of the government’s zero-billing policy in DOH-run hospitals..
In the event of underfunding or delays in the reimbursement, DOH-run hospitals are forced to impose “necessary charges,” which effectively bumps off the government’s zero balance billing policy.
For this year’s national budget, PhilHealth was given zero subsidy allocation.
BROADER UHC LAW
The health department said that the policy aims to provide completely free hospitalization for patients admitted under basic accommodation in DOH-run hospitals.
Herbosa however emphasized that the policy covers individuals (regardless of socioeconomic status) confined in “basic accommodation” rooms or wards under DOH-run medical facilities nationwide.
He noted that the policy, previously available only to indigent patients, has now been expanded with the goal that all patients receiving treatment in basic accommodations under DOH hospitals will no longer pay a single centavo.
To qualify, Herbosa stressed that patients must choose “basic accommodation,” if only to ensure full coverage of hospital expenses in DOH-run facilities.
The DOH chief however clarified that the coverage excludes private hospitals, patients who choose private rooms, and those undergoing elective procedures.
SELECTED HOSPITALS
For clarity, all DOH hospitals are public, but not all public hospitals are DOH hospitals.
DOH hospitals are public facilities directly operated and funded by the Health Department. They are typically tertiary or regional medical centers—larger, better equipped, and capable of offering specialized and referral services.
These hospitals are expected to implement DOH policies, like “zero balance billing,” more strictly.
Public hospitals, in general, include DOH hospitals, LGU hospitals (run by provincial, city, or municipal governments), military hospitals, and public university hospitals. All are government-funded and serve the public, often at low or no cost.