Governance gaps keep universal healthcare elusive in the Philippines

By Francis Allan L. Angelo

Seven years after the Universal Healthcare (UHC) Act became law, many Filipinos still count the cost before seeing a doctor, make do with unfinished treatments, or go without care altogether.

That reality anchored the latest Ateneo Breakthroughs lecture on 28 April 2026, where Veincent Christian F. Pepito, assistant professor and researcher at the Ateneo School of Medicine and Public Health’s Center for Research Innovation, laid out the structural obstacles standing between the law’s promise and its implementation.

Pepito, who has published more than 70 papers on public health, clinical medicine, and health policy, conducted a series of key informant interviews and focus group discussions with stakeholders spanning all levels of government — from senior officials of the Department of Health (DOH) and the Philippine Health Insurance Corporation (PhilHealth) to regional and local implementers, facility administrators, health providers, and patients.

Using the World Health Organization’s six building blocks framework, his research classified barriers across governance and leadership, health information systems, financing, service delivery, health workforce, and medicines and technologies.

On governance, the devolution of health services to local government units emerged as one of the most significant structural impediments to UHC implementation.

A siloed relationship between the DOH and PhilHealth further fragments coordination, while the absence of technical, managerial, and financial integration across the public and private sectors prevents the system from functioning as a whole.

Local political dynamics add another layer of difficulty: in some provinces, mayors from opposing parties have withheld participation in provincial health programs, with coordination breaking down along political lines rather than public health need.

Pepito noted that health rarely secures political priority. Unlike roads, flood control, and infrastructure — which are visible to communities and useful during election cycles — health investments yield outcomes that are often unseen and difficult to campaign on.

Procurement rules present an additional barrier. Medicine and equipment suppliers are frequently disqualified by bid requirements or submit failed bids, leaving public facilities with periodic shortages of essential drugs and consumables.

Private sector providers cited a regulatory environment they described as punitive rather than incentive-based as a key reason for not joining UHC programs — making participation financially unattractive and legally risky.

On the health workforce, Pepito found that medical schools are not adequately preparing graduates for the realities of UHC implementation, including procurement, administration, and engagement with local chief executives.

Specialist physicians remain heavily concentrated in Metro Manila, and local government budget caps on personal services — set at 45 to 55 percent of total expenditure depending on income class — prevent many municipalities from hiring the additional health personnel their programs require.

Financing gaps are likewise acute. Some local government units allocate only 12 percent of their budgets to health, far below the 20-percent requirement — a figure cited by a public sector respondent in Pepito’s research.

The self-employed sector presents a structural gap in health financing, as many in this group do not pay PhilHealth premiums but still seek medical care when they fall ill.

Claims processing disputes between facilities and PhilHealth have also created friction, while some benefit package valuations remain pegged to 2013 cost levels despite significant increases in the price of medicines and services in the years since.

On health information systems, the lack of interoperability between government platforms — including the e-Consult system used in primary care and the Hospital Management Information System (HMIS) used in hospitals — prevents patient data from following individuals across care settings.

Poor internet connectivity in geographically isolated and disadvantaged areas (GIDAs) has compounded this problem, though Pepito noted that satellite internet access has alleviated connectivity issues in many such areas.

Cybersecurity vulnerabilities across health agencies also remain unaddressed, underscoring the need for investment in health information technology infrastructure.

On public awareness, Pepito flagged a widespread misconception: many Filipinos believe UHC makes healthcare free, when it is in fact a risk-pooling system that depends on regular premium contributions.

Achieving 80-percent UHC coverage would require USD 1,500 per person in health spending — a figure that illustrates the scale of the funding challenge the country faces.

Despite the breadth of barriers, Pepito pointed to several efforts already underway. The Commission on Higher Education issued CHED Memorandum Order 17, series of 2025, reorienting health professions curricula toward UHC principles.

Reforms adopted during the COVID-19 pandemic, such as those implemented by Quezon City, have demonstrated how local governments can adapt health systems to advance UHC goals — and sustaining these reforms was among Pepito’s recommendations.

PhilHealth has also rebranded its primary care benefit package as Jakap, and a new government procurement law with recently signed implementing rules is expected to address longstanding supply chain weaknesses, though its impact on UHC implementation has yet to be documented.

Pepito also advocated for responsible self-care — practices that reduce the burden on the health system without interfering with conventional medicine — as a complementary strategy given the resource constraints facing both government and households.

On the most beneficial near-term intervention, Pepito pointed to health information systems reform: building interoperability so that data follows the patient from primary care through tertiary referral, rather than being locked in disconnected platforms.

“A health system must be built, coordinated, financed, staffed, trusted, and made intelligible to the people it is meant to serve,” said Dr. Filomeno Aguilar, Assistant Vice President for Research, Creative Work, and Innovation, in his opening remarks for the lecture — underscoring that goodwill alone is insufficient without structural change.

Pepito closed by framing UHC as a shared responsibility: for individuals to pay their premiums, practice preventive health habits, and hold institutions accountable for the public funds entrusted to them.

For millions of Filipinos, he said, healthcare is not an abstract policy goal — it is a daily risk, a financial burden, and far too often, an unanswered question.