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MANILA, Philippines — The government’s zero-balance billing policy, touted by President Ferdinand Marcos Jr. in his fourth address to the nation, has raised more questions than answers.
Many are unsure if the policy is limited to indigent patients or if it applies to all. There’s also uncertainty about whether it covers all medical expenses, including procedures, medicines and operation expenses.
The clear-cut answer is this: as long as the patient is admitted to a basic or ward accommodation in a Department of Health-listed hospital, their expenses are covered under the zero-balance billing policy. In this case, they should not incur any out-of-pocket costs.
DOH spokesperson Albert Domingo confirmed this to Philstar.com in a message.
According to the Universal Health Care Act, a basic or ward accommodation "refers to the provision of regular meals, a bed in a shared room, fan ventilation and shared toilet and bath."
Regardless of one's socioeconomic status, age, or job, Domingo said they are eligible for zero-balance billing. Simply put, every Filipino can avail of free-of-charge basic or ward accommodation services at the listed hospitals.
"Ang current policy ngayon is as long as kayo po ay magpapa-admit sa isang basic accommodation or ward accommodation ng isang DOH hospital, kahit kayo po ay magsasaka o manager, kayo ay covered ng polisiya," he said on Friday, August 1, over One News PH's "Morning Matters."
(The current policy is that as long as you are admitted to a basic or ward accommodation in a DOH hospital, whether you're a farmer or a manager, you are covered by the policy.)
Where to avail
The zero-balance billing policy currently applies to 87 DOH hospitals nationwide. This includes five hospitals still under development and four run by government-owned and controlled corporations (GOCCs), which have yet to fully enforce the zero-balance billing policy.
While GOCC-run hospitals like the Philippine Heart Center, Lung Center, National Kidney Institute and Philippine Children’s Medical Center aren’t owned or operated by the DOH, Domingo said the department still chairs their board of directors.
He also clarified that not all public hospitals are DOH hospitals, so it is crucial to refer to the verified list of hospitals provided by the DOH and the Presidential Communications Office (PCO), should patients seek to avail zero-balance billing.
PhilHealth membership
Another source of confusion is whether anyone can truly avail themselves of the free-of-charge service. According to Domingo, the categorical answer is yes — because every Filipino is considered a PhilHealth member under the Universal Health Care Act.
But in practice, not all are registered with PhilHealth yet. Domingo said this should not be a concern for patients at DOH hospitals, as they will be assisted through PhilHealth’s Point of Service (POS) program.
Patients who are not yet registered but seek to avail of the zero-balance billing can sign up at the hospital’s PhilHealth office or desk.
What if you're unable to pay the contributions?
Domingo said that even those unable to pay contributions are still considered members. They fall under the category of indirect contributors, whose coverage is funded through government subsidies — including revenues from taxes like the sin tax.
The confusion can be traced back to the No Balance Billing policy introduced in 2011, which covered only select groups, including sponsored PhilHealth members, household workers, senior citizens and retirees classified as lifetime members.
Domingo clarified that the new zero-balance billing policy mentioned by the president applies to all registered PhilHealth members. This means patients no longer need to undergo interviews or be classified as indigent to avail of the benefit.
Are all expenses covered?
So what exactly is covered under the zero-balance billing policy?
Domingo said it may sound hard to believe, but the answer is simple. Whatever the case may be, as long as the patient is admitted to a basic or ward accommodation, all expenses during their stay are covered.
This includes medical procedures, operations and medicines — all free of charge at DOH-listed hospitals, provided the patient remains in basic or ward accommodation, he stressed.
"Yes, kasama ang operation expenses. Kahit anong kaso ka, basta ikaw ay nasa basic o ward accommodation," Domingo said.
(Yes, operation expenses are included. No matter your case, so long as you’re admitted to a basic or ward accommodation.)
"Anything and everything that you need to get well, as long as you are in a DOH hospital under basic accommodation, is covered," he added.
To explain the policy’s coverage, Domingo recalled his recent visit to a DOH hospital.
In the obstetrics ward, a mother who delivered twins didn’t have to pay for the procedures needed, and even the newborn screenings were covered. At the orthopedic ward, a patient with a broken leg required a metal implant. That, too, fell under zero-balance billing.
He clarified, however, that procedures done in emergency rooms aren’t included, as patients are still considered outpatients. PhilHealth’s outpatient emergency care packages apply in those cases instead, Domingo said.
What happens after being discharged?
Other outpatient services like check-ups, lab work and cancer screening tests — along with some essential prescribed medicines — may be covered by PhilHealth through its Yaman ng Kalusugan Program para Malayo sa Sakit or YAKAP package.
As of May 2024, PhilHealth reported a total of 50.36 million registered members, consisting of 37 million direct and 13.36 million indirect contributors. Including their dependents, the coverage extends to roughly 87.22 million registered Filipinos.
Marcos, in his July 28 State of the Nation Address, said the zero-balance billing in DOH hospitals is supported by PhilHealth, with additional funds from the Philippine Charity Sweepstakes Office (PCSO) and the Philippine Amusement and Gaming Corp. (PAGCOR).
