IN the Philippines, a guarantee letter (GL) is a formal commitment issued by a government agency — like the Philippine Charity Sweepstakes Office (PCSO), the Department of Social Welfare and Development (DSWD) or the Department of Health (DOH) — to a hospital or service provider, promising to pay a specific portion of a patient’s medical expenses.
While it is a lifeline for many “sick and needy” Filipinos, it comes with a unique set of logistical hurdles. Let me start with the general concepts and later on my personal observations.
The primary benefit is the immediate reduction of the hospital bill. When combined with Philippine Health Insurance Corp. (PhilHealth) and the “No Balance Billing” policy in public hospitals, a GL can sometimes cover 100 percent of the remaining costs.
The Malasakit Centers Act enables patients to process GLs from multiple agencies (PCSO, DSWD, DOH and PhilHealth) in a single “one-stop shop” located within the hospital, reducing the need to travel to different government offices.
While primarily for public facilities, many private hospitals also accept GLs, provided they have an existing memorandum of agreement (MOA) with the issuing agency. GLs aren’t just for general bills; they can be specifically issued for expensive treatments like chemotherapy, dialysis, surgical implants and laboratory procedures that are often excluded from standard health packages.
Some agencies allow patients to apply for a GL even after being discharged to help settle outstanding balances, provided the required documentation is submitted.
However, obtaining a GL requires significant documentation, including a medical abstract, a statement of account and social case study reports. For a family in crisis, gathering these can be physically and emotionally draining. In most cases, one trip to the agency is not enough, resulting in more travel expenses, photocopying costs and food needs (more often than not, the waiting lines are kilometric and one has to go three or four hours earlier than the official hours to be assured of a spot.
(Note: A GL is a promise to pay the provider, not cash given to the patient. This means it cannot be used for “incidental” costs like food, specialized outside medicines, or transportation unless specifically stated by certain DSWD programs).
Not all private hospitals or diagnostic centers accept GLs. If a hospital does not have a MOA with the specific agency (e.g., PCSO), the patient must pay in cash and seek reimbursement later, which is a much slower process.
Government medical assistance programs are subject to budget availability. If an agency’s “allocation” for the month or the specific hospital is exhausted, they may stop issuing GLs until the next budget cycle.
Most agencies allow only one GL per hospital bill or a specific number of requests per year. This can be problematic for patients with chronic conditions requiring long-term, repeated assistance.
Question: can multiple guarantee letters cover a single expensive medicine?
Yes, you can absolutely use multiple guarantee letters to cover a single expensive medicine or medical procedure. In fact, this “layering” of assistance is the primary reason the Malasakit Centers were created — to help Filipinos “stack” aid from different agencies to reach a high total amount.
However, as of 2026, there have been significant updates to how this works under the Medical Assistance to Indigent and Financially Incapacitated Patients (Maifip) program: if a medicine costs P50,000 and one agency only provides P15,000, you can seek the balance from others. The standard sequence is usually:
1. PhilHealth: They are always the “first look.” They deduct their specific package amount first.
2. DOH (Maifip): Often the largest source of aid in government hospitals.
3. DSWD (Assistance to Individuals In Crisis Situations): Provides GLs that can be used for medicines, especially if the hospital pharmacy is out of stock, and you need to buy from a partner private drugstore.
4. PCSO: Typically handles large-scale requests like chemotherapy drugs or specialized implants.
Today “political” GLs are not honored. Starting early 2026, the DOH has moved to eliminate the need for guarantee letters from politicians (congressmen or senators) to access Maifip funds. Assistance is now intended to be strictly based on medical need and clinical assessment within the hospital.
If you are in a public hospital ward, the goal is now “zero balance.” Instead of you running around for multiple GLs, the hospital is supposed to internalize these funds to cover your medicine automatically.
If the expensive medicine is unavailable in the government hospital, the DSWD and DOH now have expanded memorandums of agreement (MOAs) with private pharmacies (like Globo Asiatico or Mercury Drug in some areas) so your GLs can be honored there directly. The logical sequence of preparation is:
First, visit the Malasakit Center first: do not go to the agencies separately. The center has representatives from PhilHealth, DOH, DSWD and PCSO in one room specifically to coordinate how much each will contribute to your bill.
Second, if you are buying from an outside pharmacy, you must get a formal price quote from them. The GL will be made out specifically to that pharmacy for that exact amount.
Thirdly, check for “Maifip” availability: Ask the hospital social worker if the medicine can be covered under the Maifip program directly, which might save you the trouble of applying for a separate PCSO or DSWD letter.
Let me now share an experience which I consider a fluke in the system: A bottle of my medicine has a retail price of P116,500 per bottle of 90 capsules. At three capsules per day, the bottle lasts 30 days, or one month. Discounted price is P104,850. Government agency (A) issued a guarantee letter worth P150,000. Another agency (B) issued a GL worth P40,000.
For GL (A), the private provider gave me one bottle. So P150,000 GL (A) less P104,850 discounted price = P45,150, the remaining balance of GL (A).
However, I was told by the provider that I cannot apply the other GL (B) to supplement the remaining balance of GL (A)!
So, I have to source out P59,700 to get another bottle from GL(A) and an additional P64,850 for GL(B) for a total of P124,550 for three bottles in order that both GLs do not go to waste. That is a lot of money to raise every three months. That’s why I’m asking for assistance in the first place, right?
Why do I need three bottles? The government agencies told me that I can only renew requests for assistance every three months.
There must be a better way to extend medical assistance (any suggestion will be greatly appreciated).
