The Department of Health’s Medical Assistance for Indigent and Financially Incapacitated Patients (MAIFIP) program was created to assist patients who lack adequate coverage. As a safety net, it has its uses. But a serious problem arises when a temporary patch for the shortcomings of a universal social health insurance system becomes a permanent, parallel system.
We already have a state health insurer, the Philippine Health Insurance Corp. (PhilHealth), and its mandate under the Universal Health Care (UHC) Act (RA 11223) is clear: universal social health insurance for all Filipinos. The law makes PhilHealth the primary mechanism for shielding families from catastrophic health expenditures and reducing out-of-pocket costs, so that life-saving treatment never pushes a household into poverty.
If PhilHealth’s coverage is inadequate, the correct response is to strengthen PhilHealth. It is not to keep our social health insurance weak while continually expanding case-by-case medical assistance. MAIFIP has, in fact, become an institutionally anomalous, parallel financing mechanism.
The reason is straightforward. Under the UHC Act, individual health services are to be financed primarily through social health insurance, with PhilHealth contracting providers and paying for those services. Every Filipino is entitled to immediate PhilHealth eligibility. MAIFIP, by contrast, is an ex-post mechanism: it kicks in only after illness has struck and the bills have arrived.
MAIFIP was originally meant to fill PhilHealth’s gaps, not to become an alternative financing system. Former Health Secretary Teodoro Herbosa acknowledged as much, explaining that the program arose because PhilHealth’s “support value” was too low, so legislators placed funds in the Department of Health (DoH) to help indigent patients achieve no-balance billing. The program, he added, subsequently “expanded and expanded.”
But when that supplementary fund becomes massive and permanent while PhilHealth itself, especially since 2023, is chronically defunded and starved of the resources it needs to expand its benefit packages, we run into serious structural problems. There are at least five.
First, it fragments health financing. Instead of pooling resources in a single national purchaser, as the UHC Act envisioned, the government maintains separate funding streams: PhilHealth, MAIFIP, the Assistance to Individuals in Crisis Situations (AICS) of the Department of Social Welfare and Development (DSWD), the Philippine Charity Sweepstakes Office (PCSO) Medical Assistance Program, and others. These pools overlap inefficiently. Worse, they weaken PhilHealth’s leverage as a unified buyer to negotiate lower prices for medicines, hospital procedures, and health services.
Second, it duplicates. MAIFIP finances many of the same services the UHC framework expects PhilHealth to progressively cover: inpatient and outpatient care, medicines, diagnostics, professional fees, and other treatment. One can reasonably ask: why are billions of pesos for individual health services coursed through discretionary assistance rather than built into predictable PhilHealth benefit packages?
Third, it is reactive rather than prepaid. Social health insurance pools risks before illness occurs; medical assistance responds after people are already in financial need. That is exactly what UHC is supposed to move away from. Section 7 of the UHC Act deliberately emphasizes pre-payment because it makes health expenditures predictable.
Fourth, it undercuts strategic purchasing. PhilHealth can use its purchasing power to negotiate rates, define benefit packages, impose quality standards, collect claims data, contract provider networks, and redesign payment incentives. The UHC Act specifically directs PhilHealth toward performance-based prospective provider payment. MAIFIP largely pays individual bills.
Instead of endlessly expanding MAIFIP, why not properly resource PhilHealth to fast-track Diagnosis-Related Groups (DRGs), a transition the UHC Act mandates? DRGs require substantial fiscal support, but they are precisely the reform needed to replace outdated case rates with reimbursements that reflect the real cost of complex hospital care. Funding this shift would fix PhilHealth’s payment problems at the root rather than paper over them with discretionary assistance.
Fifth, it invites patronage. A case-by-case mechanism is structurally more open to political capture than an automatic insurance entitlement. Once politicians position themselves between the public fund and the patient, a public entitlement becomes perceived as political generosity. The concern goes beyond inefficiency: a fragmented assistance system reproduces the patron-client relationships that universal social insurance is supposed to replace.
To summarize, MAIFIP may have been justified historically as an emergency response to inadequate PhilHealth coverage. But a gap-filling mechanism should not become a permanent parallel system, much less one that grows while the institution legally mandated to provide universal social health insurance is defunded.
We saw this clearly at the recent meeting of the House Appropriations Committee’s Budget Amendments and Review Subcommittee (BARSC). Lawmakers easily agreed to double the MAIFIP budget from P24 billion to P49 billion, precisely because it serves as discretionary currency to hand out to constituents who come knocking.
Amendments were even floated to revert MAIFIP into a generic Medical Assistance Program (MAP) covering not just the indigent but also non-indigent patients vulnerable to catastrophic hospital costs. That is no longer funding a safety net. It is building a full-fledged parallel health financing mechanism, a discretionary fund growing to a scale that rivals PhilHealth, the strategic purchaser designated by law. Does Congress truly prefer that sick Filipinos keep lining up outside their offices for personal favors, rather than see comprehensive PhilHealth coverage automatically cut their hospital bills at the point of care?
Yet when it comes to fully funding the P244 billion minimum that PhilHealth needs to guarantee transparent, rules-based coverage for all, the same politicians cannot muster the same political will. Why is an automatic public entitlement sidelined while discretionary patronage is fast-tracked?
To the Executive and Congress: prioritize PhilHealth. Provide the budget it urgently requires instead of continually inflating MAIFIP. Uphold a rights-based system, not patronage politics. The people’s money must build a durable universal social health insurance system, not serve as political capital.
So, is medical assistance a guaranteed right, or a personal favor that creates a debt of gratitude to a politician?
This is the true litmus test. When a Filipino falls ill, they should not have to ask, “sino ang lalapitan ko?” (Who can I approach for help?) They should be able to say, “covered ako, karapatan ko ito” (I am covered. This is my right).
Ma. Victoria R. Raquiza, PhD, is co-convenor of Social Watch Philippines. She is a professor at the National College of Public Administration and Governance, University of the Philippines Diliman.