JOY, the mother of a person with a disability (PWD), sought financial assistance from a Malasakit Center at the East Avenue Medical Center to help pay for her child’s counseling. She was almost rejected because her husband is a middle-income earner.
“I was almost rejected, but when I told her (Malasakit personnel) that I have a PWD child and I don't have a job, she reconsidered. My husband is the only provider, and that’s why I availed the program in the first place,” she said in Filipino.
Malasakit Centers are one-stop shops designed to streamline medical assistance programs from several government agencies, such as the Department of Health (DOH), Philippine Health Insurance Corp. (PhilHealth), Philippine Charity Sweepstakes Office (PCSO), and Department of Social Welfare and Development (DSWD), for indigent patients.
To qualify, patients must bring documents that prove they are indigent. They will then be screened if they qualify for the program.
Pete shared a similar experience when his mother, a senior citizen, underwent emergency angioplasty at the Philippine Heart Center.
He said his brother processed their application, but was told that only two applicants were accommodated daily.
“It’s hard for people like us who really need the financial assistance,” Pete said in Filipino. They queued for aid from the Malasakit Center several times, and once they were accepted, instead of directly covering part of their hospital bill, Pete said the Malasakit Center only collected and forwarded their Guarantee Letters (GL).
“Eventually, the Malasakit [Center] did not cover our hospital bill. They only forwarded the GLs,” he said.
Guarantee letters are documents issued by politicians to hospitals, ensuring payment for an indigent patient's medical expenses.
The DOH said that as of last January, the issuance of GLs is no longer necessary to qualify for the Medical Assistance for Indigent and Financially Incapacitated Patients (Maifip) program. New guidelines will be issued by the end of February.
Pete said his mother’s hospital bill reached P202,000. About P105,000 was covered through various GLs, leaving them with a balance of nearly P98,000.
Unable to immediately settle the bill, the family applied for a promissory note, which was initially due on Feb. 6. They later requested an extension and now face penalties.
“There are always many patients queuing, only to be rejected because of a lack of requirements or the need to go to a separate office,” Pete said, questioning the initial mandate of Malasakit Centers.
Some patients he had spoken to claimed that the Malasakit Center used to be more helpful, but now appears to lack funds.
No quota
Health Undersecretary Albert Domingo denied such claims.
“There is no uniform policy that sets any 'quota' per day. Neither is there a uniform policy on how to determine eligibility. Operations depend on the management decisions of each and every hospital hosting,” Domingo said.
He advised complainants to take their problems up with hospital management.
He also noted that zero balance billing in basic accommodations at DOH hospitals can be availed of without Malasakit Center intervention.
For health reform advocate Dr. Tony Leachon, the only way to resolve these issues is to transfer funds from welfare programs, such as the DSWD's Assistance to Individuals in Crisis Situations (AICS) and the Maifip — which can both be availed in Malasakit centers — and the Tulong Panghanapbuhay sa Ating Disadvantaged/Displaced Workers (Tupad) to PhilHealth.
Leachon said that since these programs are medically and welfare-related and are discretionary in nature, centralizing their funding under PhilHealth would make assistance more systematic and efficient.
This would allow the agency to fully finance health care services and ensure zero balance billing for all Filipinos.
“If these funds are put back into PhilHealth, it will be largely funded. Whether you are poor, middle class, or upper class, we can achieve zero balance billing for all,” he said.
Despite the challenges, the patients acknowledged the advantages of seeking help from Malasakit Centers.
Joy, however, called for better funding in hospitals and proper compensation and support for health care workers.
“If they’re given the right salary and facilities, they can serve the people better,” she said.
Leachon, a leading health reform advocate, is still skeptical over the DOH’s latest promise to provide free ward accommodations for PhilHealth’s middle-class contributors, citing a long history of unfulfilled government commitments and massive funding gaps.
“In the face of repeated promises, I remain apprehensive. I cannot simply believe in rhetoric when the record speaks otherwise,” he said.
He pointed to a series of unresolved financial issues that, in his view, undermine the credibility of new government health care promises.
He cited the P60 billion transfer of health funds to the national treasury, which the Supreme Court declared unconstitutional; P74 billion PhilHealth funding gap; P220 billion in unpaid debts from Pagcor and PCSO; and Maifip program risks.
“These are not solutions. These are promises deferred,” Leachon said.
He called for a more fundamental reform: transferring the budgets of Maifip, AICS (Assistance to Individuals in Crisis Situations), and Tupad directly to PhilHealth.
He argues that this consolidation would reduce out-of-pocket expenses to 10 percent, providing genuine financial relief, strengthening PhilHealth, upholding the Universal Health Care Law, and restoring public trust in the health system by ensuring transparency and efficiency.
The debate over the DOH’s new policy for PhilHealth direct contributors highlights deeper questions about the sustainability and priorities of the Philippine health financing system.
Experts like Leachon warned that unless the government addresses the root causes of funding shortfalls and consolidates health assistance programs, promises may remain unfulfilled.
