PhilHealth convenes TAC to refine disease coverage selection process

PHILIPPINE Health Insurance Corp. (PhilHealth) President and CEO Edwin Mercado convened the Technical Advisory Council (TAC) for its second meeting on March 10, 2025.

The session focused on improving actuarial assumptions and refining the disease coverage selection process.

PHILHEALTH TECHNICAL ADVISORY COUNCIL MEETING Philippine Health Insurance Corp. President and CEO Edwin Mercado (seated, third from left) with members of the Technical Advisory Council during the TAC second meeting on March 10, 2025. PHILHEALTH PHOTO

During the meeting, experts discussed practical ways to strengthen actuarial projections that will directly benefit PhilHealth members.

The council emphasized the need for more detailed, market-based assumptions that assess whether current health care providers can actually deliver the covered services.

"By improving our actuarial assumptions, we can better predict health care costs and utilization patterns," Mercado explained.

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.

"We not only know where doctors and other professionals are, but we also know how many patients they can see in a day without compromising the quality of medical services. 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," the PhilHealth chief said.

TAC is composed of health economist Tessa Tan-Torres Edejer, who served as the coordinator of the Unit on Costs, Effectiveness, Expenditure and Priority Setting in the Department of Health Financing and Governance, World Health Organization in Geneva, Switzerland; health systems, policy and financing expert Carlo Irwin Panelo; actuary, mathematician and seasoned insurance executive Honesto Nuqui Jr.; university professor, scientist and chancellor Michael Tee; health economist and well-published senior research fellow Valerie Gilbert Ulep; practicing surgeon and seasoned hospital administrator Vivencio Jose Villaflor; and information technology and digital transformation expert Henry Aguda.