The Governance Commission for Government-Owned or -Controlled Corporations (GCG) has announced that the Philippine Health Insurance Corporation (PhilHealth) is poised for a major restructuring aimed at enhancing operational efficiency and addressing long-standing challenges.
According to a statement released Wednesday, the overhaul involves a redesigned organizational framework that introduces 503 units and 7,149 job positions. This new setup is expected to improve PhilHealth’s service delivery capabilities and better support its broader responsibilities under Republic Act No. 11223, also known as the Universal Health Care Act.
GCG emphasized that this transformation is a critical step toward streamlining operations, strengthening public health service, and modernizing internal systems. Some of the key issues being addressed include an outdated workforce structure, fragmented data systems, inefficiencies in strategy execution, and recurring problems with benefit claims processing.
To optimize efficiency, GCG highlighted that five core service areas—finance, legal, IT, procurement, and human resources/general administration—will be centralized. This centralization is anticipated to eliminate redundant practices, reduce inconsistencies, and promote a more cohesive approach to managing the agency.
“The reorganization will enable PhilHealth to be more responsive to the needs of the public and elevate the standard of healthcare delivery in the country,” the GCG stated.
The restructuring also introduces a realignment of internal controls. PhilHealth’s internal audit department will now report directly to the Audit Committee of its Board of Directors while maintaining an administrative link to the President and Chief Executive Officer (PCEO) of the organization.
Another major development is the creation of the Benefit Payment Appeals Office (BPAO), which will be tasked with managing appeals related to benefit claims. This office is expected to expedite case resolutions and foster better coordination with healthcare providers.
Health Secretary Teodoro Herbosa confirmed the Department of Health’s (DOH) involvement in the initiative, noting their close collaboration with the GCG in crafting a structure that supports the full implementation of Universal Health Care.
“Both PhilHealth personnel and the public have long awaited this restructuring. The DOH and PhilHealth’s Board have been meticulous in reviewing every component of the plan,” Herbosa said in a separate statement.
The groundwork for this reform began in 2022 when PhilHealth first filed its restructuring proposal. In 2023, GCG gave its nod to a partial reorganization and subsequently asked PhilHealth to submit more supporting documents. The evaluation and consultation process is expected to continue through January 2025.