No Safety in the Social Safety Net
Maria Lourdes Sulit’s husband Marvin desperately needed surgery for his brain hematoma. She already had to switch from one hospital to another to cut the price of her husband’s brain surgery by two million pesos. However, for a family struggling to make ends meet, the cost of the surgery was simply too high for the Sulit family to afford. Marvin died seven hours after his confinement, with the bill for his short stay at the hospital coming to 200,000 pesos. When Maria tried to claim Marvin’s PhilHealth benefits, she was informed by hospital personnel that her late husband was ineligible. Despite paying for the PhilHealth contributions for 25 years, Marvin did not qualify because he died within 24 hours, falling short of PhilHealth’s 24-hour confinement rule.
This issue is more devastating than one might realize. Social safety nets like PhilHealth, Social Security System (SSS), and Pag-IBIG are supposed to support vulnerable families during economic shocks, natural disasters, and other life-changing events. One might compare them to the rescue nets—equipment vital to saving a life. If a rescue net fails in its purpose due to poor structural integrity, it points to a broader manufacturing issue. Similarly, PhilHealth’s latest scandal exposed deep systemic failures within the insurance provider, reflecting broader issues with the Philippines’ social safety net and its desperate need for reform.
PhilHealth’s 24-hour confinement rule prevents the collection of government funds for minor checkups and unnecessary admissions. However, the policy fails to take into account emergency admissions and death within 24 hours, and the fact that hospital bills tend to compound fast, leaving ordinary families unable to settle the payment. PhilHealth only began reviewing this policy after Sulit’s story went viral on social media, implying that other people have been experiencing the same situation. The fact that this case only received action after public outrage over Sulit’s story on social media is evidence of institutional negligence. Dr. Tony Leachon, former PhilHealth official and health advocate, has called to abolish the 24-hour rule altogether, stating that “the 24-hour confinement rule undermines the very purpose of social healthcare, which is to provide support at the greatest moment of need.”
To address the glaring issue, PhilHealth released another circular in 2024, stating that members are eligible for an Outpatient Emergency Care Package (OECP) for emergency admissions and sudden deaths within 24 hours. However, PhilHealth failed to disseminate this information, causing many hospitals and health centers to still follow the 24-hour confinement rule. PhilHealth’s failure to inform hospitals about OECP is a display of negligence, showing disregard towards affected families that the new policy was supposed to assist.
Bagong Henerasyon Partylist Spokesperson Bernadette Herrera spoke up about her personal experiences with the OECP, recounting the experience of a family member of hers who could only avail of the OECP through her connections to Bernadette Lico, the vice president of PhilHealth. This shows that this benefit is not readily available to the public. If the OECP can only serve Filipinos privileged with connections, then this is not a beneficial addition to the 24-hour confinement policy but rather another band-aid solution that fails to address the real problem.
Amid the current discussion, it is important to remember PhilHealth’s history of institutional failings, fraud allegations, and other controversies. Members have reported being denied PhilHealth benefits due to processing delays. Meanwhile, PhilHealth’s poor cybersecurity infrastructure has allowed hackers to steal members’ personal data. And let’s not forget the multiple fraud scandals PhilHealth was involved in, including the accusation of misallocation and embezzlement of billions of pesos from its members and the government. At this point, it’s no surprise that the Sulit family—one among many unreported others—experienced this injustice. Although many critics have pointed out these systemic issues whenever a scandal occurs, the controversy simply dies without any meaningful change.
From questionable policies and widespread negligence to institutional plunder, the problems that plague PhilHealth are plenty. But these glaring issues are only the tip of the iceberg. Other social safety nets, such as SSS and Pag-IBIG, also face the same issues as PhilHealth and are also routinely the subject of numerous controversies. Even for those not directly affected, this issue still affects a vast majority of Filipinos. When the community is weighed down by problems, everyone—whether rich or poor, sick or healthy—is affected in one way or another. We, the citizens of our country, must take action and make strong calls for structural and policy-wide reforms, not just for the social safety nets but also the core systems that are supposed to uphold our society. If we wait until an emergency occurs before taking action, it will already be too late by then.
