Wednesday, July 9, 2025

President in action: Mercado convenes technical advisory council to refine disease coverage selection

PhilHealth acting President and CEO Dr. Edwin Mercado convened the Technical Advisory Council (TAC) for its second meeting March 10, 2025, focusing on improving actuarial assumptions and refining the disease coverage selection process.

The council discussed practical ways to strengthen actuarial projections benefiting PhilHealth members, emphasizing the need for detailed, market-based assumptions that assess whether current healthcare providers can deliver covered services.

“By improving our actuarial assumptions, we can better predict healthcare costs and utilization patterns,” explained Mercado. “This means we can expand benefits in a sustainable way while ensuring members can actually access the care we’re promising.”

The TAC supported Mercado’s direction to expand coverage for high-cost, high-burden diseases to increase access to critical services. For members, this translates to greater financial protection against catastrophic health expenses that previously caused significant hardship for many Filipino families.

Council Members consist of Dr. Tessa Tan-Torres Edejer, health economist who served as the Coordinator of the Unit on Costs, Effectiveness, Expenditure and Priority Setting in the  Department of Health Financing and Governance (HGF), WHO in Geneva; Dr. Carlo Irwin  A. Panelo, health systems, policy and financing expert; Honesto A. Nuqui, Jr., actuary,  mathematician, and seasoned insurance executive; Dr. Michael L. Tee, university professor,  scientist, and chancellor; Dr. Valerie Gilbert T. Ulep, health economist and well-published senior research fellow; Dr. Vivencio Jose Villaflor, a practicing surgeon and seasoned hospital administrator; and Henry Aguda, information technology and digital transformation expert.

“Going granular means understanding if our current healthcare infrastructure can deliver the services we’re covering, and developing strategies to create robust markets where they don’t exist. Ang ibig sabihin po nito, alam natin hindi lang kung nasaan ang mga doktor at iba pang mga propesyonal, ngunit alam din natin kung ilang pasyente ang kaya nilang tingnan sa isang araw nang hindi bumababa ang kalidad ng serbisyong pang-medikal,” added Mercado. “When we promise coverage for a condition, we want to ensure our members can find qualified providers to deliver that care without excessive out-of-pocket expenses or long travel times.”

Council members committed to developing a practical framework to guide this expansion while ensuring service delivery capability.

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