FIVE critical services of PhilHealth will be centralized under a restructuring program approved by the Governance Commission for Government-Owned or -Controlled Corporations (GCG) to enhance the agency’s efficiency, as well as address key operational challenges.
In a statement released late Wednesday, the GCG said the reforms, approved during the en banc meeting on June 25, aim to address several long-standing issues, including outdated workforce, fragmented data and strategy execution and issues related to benefit claims.
The five services to be centralized are finance, legal, information technology, procurement, human resources and general administration services.
“The centralization of these administrative functions is seen to address the inconsistencies and conflicts in the current operational framework of PhilHealth, maintain responsiveness to the public and enhance healthcare delivery,” GCG said.
The commission also ordered the strengthening of the internal audit office of PhilHealth in response to the magnitude and complexity of its operations.
“To foster independence and ensure checks and balances, the internal audit office shall functionally report to the Audit Committee of the Board of Directors and shall administratively report to the President and Chief Executive Officer of the corporation,” GCG said.
The GCG said the restructuring includes a revamped organizational structure — with 503 units and a total of 7,149 positions — that aims to improve service delivery and strengthen the agency’s capability to fulfill its expanded mandate under the Universal Health Care Act.
Meanwhile, in a move to improve efficiency in the disposition of benefit claims and reduce turnaround, one of the newly created units is the Benefit Payment Appeals Office.
This will be a dedicated office for appeals on benefit claims payment to improve the disposition of appeals cases and incentivize healthcare.
PhilHealth, as an attached agency to the Department of Health, is responsible for the policy coordination and guidance for the administration of the National Health Insurance Program at both central and local levels.
“Its expanded responsibilities under the Universal Health Care Act have made the restructuring necessary to ensure healthcare services are delivered more effectively to Filipinos nationwide,” the GCG said.
GCG said PhilHealth submitted its initial application for restructuring, along with the required preliminary documents, in November 2022.
Later that year, the GCG approved a partial restructuring of PhilHealth following a Memorandum from the Executive Secretary focused on evaluating PhilHealth’s performance and the need for its corporate restructuring.
To assist in the evaluation process, the GCG requested PhilHealth for additional documentary requirements and engaged in extensive consultations between May 2023 and January 2025.
Under the GOCC Governance Act of 2011, the GCG has the authority to evaluate and determine whether a GOCC should be reorganized, merged, streamlined, abolished or privatized, in consultation with the department or agency to which the GOCC is attached.
“To ensure the smooth and effective implementation of the restructuring, the GCG will closely monitor PhilHealth’s progress and require quarterly reports. PhilHealth has one year to implement the crucial services and centralization outlined in the GCG Order,” the agency said.
