The Society of Honor by Joe America

By Giancarlo Angulo

Section 6(b) of the Universal Health Care Act gave PhilHealth two years to “implement a comprehensive outpatient benefit, including outpatient drug benefit and emergency medical services.” The Act took effect on March 8, 2019, so the first mark was March 8, 2021. Konsulta, YAKAP and GAMOT are the programs people point to as the answer. This post lines up what the circulars say against what the Act asked for, and against what officials and the news said along the way. This is part 4 of 4 in The UHC Series. In part 1 I covered what the Act promises and who delivers it, in part 2 the rules under the Act and the study I could not find, and in part 3 PhilHealth’s money.

TLDR

• Konsulta’s policy is dated January 2020, but no clinic could join until the guidelines of December 2020. Services began in 2021 (1,162 people registered by March 2021). It was a primary care package: consultation, 13 lab tests and 21 drugs, paid to clinics as a yearly capitation.
• The Act’s list of services (the IRR’s Section 6.3) has more items than that. Emergency, outpatient drugs on a large scale, dental, mental health and cancer screening each appeared as separate circulars between 2023 and 2025, after both deadlines. I found nothing for palliative care or biologicals (vaccines, insulin).
• I could not find any PhilHealth document that says the comprehensive outpatient benefit has been completed. PhilHealth’s own circulars call their packages “progressive realization” towards it.
• Dialysis, not primary care, is where the outpatient money goes: hemodialysis was P71.7 billion of the P289.3 billion in claims paid in 2025 (about 25%), against P16.4 billion paid under YAKAP.
• Several headline numbers do not match the circulars. “Empaneled” is the biggest one.

What the Act asked for

Section 6(b): within two years, a comprehensive outpatient benefit, “including outpatient drug benefit and emergency medical services,” following the recommendations of the Health Technology Assessment Council (HTAC). The implementing rules (IRR 6.3) list what it must include: health professionals’ services, diagnostic, laboratory and dental services, personal preventive services, “prescription drugs and biologicals,” and other appropriate services. As I showed in part 2, the IRR counts the two years from its own effectivity (no earlier than October 25, 2021).

How the program grew, by date

Date	What	Circular
2000	PhilHealth’s first outpatient benefit, the Outpatient Consultation and Diagnostic Package	cited in PC2022-0032
2012	Primary Care Benefit 1 for indigent and sponsored members	cited in PC2019-0003
April 2019	Expanded Primary Care Benefit (EPCB): consultation, screening and drugs for seven conditions	PC2019-0003
January 20, 2020 (signed)	Konsulta policy replaces both. All Filipinos, registered with an accredited clinic. It says “effective January 1, 2020,” but PhilHealth’s own report says it was published February 12	PC2020-0002
December 2020	Accreditation rules (signed December 16) and implementing rules: capitation of up to P750 (private) or P500 (public) per registered member, 13 labs, 21 drugs. Pilots in 9 provinces and 2 cities for the first half of 2021	PC2020-0021, PC2020-0022
March 8, 2021	The Act’s two-year mark. PhilHealth had 1,162 people registered that month
December 30, 2022	Konsulta+ framework: a “comprehensive outpatient benefit package” to come	PC2022-0032
2023	Outpatient mental health package (October); GAMOT outpatient drug sandbox, P9,000 a year (December)	PC2023-0018, PC2023-0029
May 2024	Konsulta capitation raised to a P1,700 ceiling; mammogram and ultrasound added	PC2024-0013
December 2024	First outpatient emergency benefit; preventive oral health	PC2024-0033, PC2024-0034
2025	Eye care for children, rehabilitation, cancer screening (July), nationwide GAMOT, P20,000 a year (July), YAKAP launch (July 25)	PC2025-0002, -0003, -0013, -0014, -0017
2026	Maternity care outside hospitals; YAKAP and GAMOT standards merged (June)	PC2026-0004, PC2026-0007

Konsulta before 2023, from PhilHealth’s own reports

The best dated numbers come from PhilHealth’s quarterly reports to the Governance Commission for GOCCs. They are PhilHealth’s figures, and they have errors I note below.

End of	Accredited providers	People registered
March 2021	54	1,162
June 2021	87	12,474
September 2021	135	62,710
December 2021	188	213,828
March 2022	183	226,068
June 2022	437	404,081
September 2022	1,243	1,697,537
December 2022	1,678	16,739,839

• eKonsulta is not a separate program. The circulars define it as the interim web application clinics use to enter data. It was piloted in Sorsogon in 2021.
• The commitment was 25% of the population registered by the end of 2022, or 27.9 million people. The reported 16.7 million is 60% of that. It is also ten times the September figure, and I found no circular, advisory or news item that explains the jump. I would ask PhilHealth how it was counted before relying on it.
• Rollout. PhilHealth said Konsulta was “rolled out nationwide” in July 2021. At the end of September 2021 it had 135 providers.
• A PhilHealth study of 2021 data in four regions (August 2022) found only 690 people with a recorded first visit out of about 181,000 registered. It also cited an earlier pilot evaluation that reported encoding backlogs and payment delays. I could not find that evaluation.
• Audited books. COA’s audit of 2022 shows Konsulta benefit expense of P22,050 in 2021 and P228.8 million in 2022. That is tiny against 213,828 registrations at the end of 2021. It is not a finding, only a gap I can’t explain.
• Money rules. Capitation was paid 40% for registrants with a first visit and 60% on year-end performance. So “P500 or P750 per registered member” in the press release was a maximum, not a payment per registration.
• News. I found no mainstream coverage of the 2020 policy, and none of provider payment delays or medicine shortages in 2021–2022. Several outlets (PNA, PIA, Manila Bulletin) were blocked for me. In October 2022 PhilHealth’s own spokesperson said the roughly 1,270 enrolled providers were not enough, and in December 2022 a senator called on PhilHealth to implement the “comprehensive outpatient benefit package” fully.
• Konsulta+ (December 23, 2022) is a framework with no benefit table and no rates. It ties itself to Section 6(b) and says PhilHealth would contract exclusively under it for primary care and outpatient services “starting 2025.”

I could not obtain the Board resolutions behind these circulars (No. 2479 of 2019, which expanded primary care to all Filipinos, and No. 2746 of 2022, the sandbox). I also found no DOH memo on Konsulta itself.

Item by item against the Act’s list

“Found” means a PhilHealth circular exists. It does not mean the service is available to you where you live.

Section 6(a)/(b) and IRR 6.3 item	What I found	Limits worth knowing
Consultation	Konsulta, which grew into YAKAP	You must register with a clinic and have a first visit. Private clinics may charge up to P900 a year; public clinics may charge nothing for covered services
Laboratory and diagnostics	15 listed tests; six cancer-screening tests	The lists are closed. Tests outside them have no outpatient benefit I could find
Prescription drugs	GAMOT: 75 listed drugs	P20,000 a year, fixed prices per item, prescribed through the GAMOT app by authorized physicians
Emergency services	Outpatient Emergency Care Benefit; ambulance case rates	Patient must be discharged within 24 hours of arriving in the emergency room. Excludes emergency care at home
Dental	Preventive oral health only	P1,000 per year; two visits; emergency tooth extraction
Mental health	Outpatient package, P9,000 general and P16,000 specialty a year	The package does not pay for the medicines
Preventive	Inside Konsulta/YAKAP; cancer screening	No PhilHealth-paid outpatient vaccine benefit found
Rehabilitative	Physical medicine and assistive devices (2025)	Needs a physiatrist’s assessment
Palliative	Not found
Biologicals	Not found	The GAMOT list has no vaccine or insulin entry

The table follows the Act’s list, but reading every circular turned up outpatient packages that do not fit it neatly (dates are listing dates). An outpatient HIV/AIDS treatment package rests on a 2009 Board resolution and was last revised on December 22, 2021 (PC2021-0025). A package for secondary prevention of rheumatic fever and rheumatic heart disease was listed on July 12, 2019 (PC2019-0005). Outpatient therapeutic care for severe acute malnutrition in children 60 months and below followed on August 8, 2024 (PC2024-0017). Outpatient hemodialysis was covered up to 144 sessions in circulars for 2020 and 2021 (PC2021-0002, PC2021-0009) and 156 sessions from 2023. COVID-19 testing, community isolation and home isolation packages ran from 2020 to 2022. The emergency benefit was revised on October 31, 2025 (PC2025-0020) and extended to ambulance service on November 12, 2025 (PC2025-0022). I found no palliative or hospice benefit in any circular, and no PhilHealth-paid outpatient vaccine or insulin benefit.

Karl Garcia covers the mental health package, with the same P9,000 and P16,000 figures, in Mental Health as National Infrastructure. He asks whether the benefit is usable outside major cities, a question the circulars cannot answer.

One fairness point that cuts the other way: the 2020 circulars already listed consultation, 13 labs and 21 drugs, and the first clinics registered people in 2021, so some of the benefit was running by the Act’s mark (very thinly) and before the IRR’s. What came later, after both deadlines, was the rest of the IRR’s list.

What was said, and what the documents show

I checked 49 claims from PhilHealth releases and news reports against the circulars and PhilHealth’s own data. Of those, 18 were supported, 12 partly, 4 not supported, and I could not check 15. The ones that matter most:

1. “Empaneled.” PhilHealth said 26.75 million Filipinos were empaneled in January 2026 and that YAKAP was “reaching” 33.2 million in May. The circular (PC2025-0017) defines empanelment as coming after a first patient encounter and a signed agreement. PhilHealth’s own statistics show 40.0 million registrations at the end of 2025, but only 14.7 million with a first encounter. At June 30, 2026 the registered figure was 27.2 million, lower than the 33.2 million claimed six weeks earlier.
2. “Free medicines for every Filipino.” Everyone is eligible. But getting the medicine needs registration, a first encounter, a prescription from an authorized physician through the GAMOT app, one of the 75 listed drugs, and staying within P20,000.
3. Free lab tests. GMA reported 13 and VERA Files reported about 20. The 2024 circular lists 15. The number 13 matches the 2020 list.
4. P1,700 “per patient seen.” The circular sets a ceiling per registered member with a first encounter: P680 up front and P1,020 tied to year-end targets.
5. How much GAMOT is used. PhilHealth’s 2025 financial statements show P50.7 million of GAMOT spending, about 0.016% of its benefit expense. GAMOT providers went from 41 in Metro Manila (September 2025) to 2,983 on PhilHealth’s July 2026 list. I found no data on how many people used it.
6. eKonsulta. An advisory set it to shut down on July 1, 2026. A later one, signed June 30, 2026, keeps it running to December 31 for clinics that have not moved to a new system. The vendor who said so was right.

On what went wrong, officials and the news agree on some points. PhilHealth itself acknowledged in February 2026 that members had trouble getting GAMOT prescriptions at some clinics, and set a readiness checklist for clinics. I did not find reports of delayed payments to clinics, pharmacy arrears or doctors dropping out, and I found no COA audit findings on YAKAP or GAMOT. That means I did not find them, not that they do not exist.

Money

The Act ties outpatient benefits to the lowering of out-of-pocket costs. PSA’s national health accounts put households’ share of current health spending at 41.2% in 2025, from 44.4% in 2023 (see part 3). At a Senate briefing on September 4, 2026, PhilHealth president Beverly Ho called 37% by 2028 the realistic target. None of those statements separates outpatient care, and I found no document that links YAKAP or GAMOT to the target.

How big is primary care in the whole country? PSA’s national health accounts put primary health care spending from all payers at P863.8 billion in 2025, which is 49.8% of current health spending. That share was 55.0% in 2023 and 54.0% in 2024 (both revised). In the same two years PhilHealth’s claims paid more than doubled (see part 3). I am not claiming one caused the other. For scale, PhilHealth’s YAKAP and Konsulta benefit expense was P14.6 billion in 2025, about 1.7% of that national total. The two numbers are on different bases (PhilHealth’s accrued benefit expense against PSA’s spending by all payers, including households and local governments), so read it as an order of magnitude, not a ratio. PSA’s primary care total includes out-of-pocket payments and government facilities, so PhilHealth’s capitation is a small part of it.

Where the outpatient money actually goes. Dialysis is an outpatient service, and it dwarfs everything above. PhilHealth’s Stats and Charts 2025 lists the hemodialysis procedure first among paid claims: P71.7 billion for 7.2 million claims, out of P289.3 billion paid in 2025. That is about 25% of the amount and 38% of the claims (my arithmetic). PhilHealth president Beverly Ho said the same in October 2026: “Twenty-five percent of what we spend in terms of payout goes to dialysis,” roughly P100 billion of P400 billion in total disbursement (Manila Times, October 3, 2026). Her base (disbursement) differs from the claims total (claims paid), and PhilHealth’s 2025 financial statements show benefit expense of P323.6 billion. She used it to argue for primary care: early treatment of hypertension and diabetes could prevent kidney disease. Against that, YAKAP claims paid were P16.4 billion in 2025 (Stats and Charts; the financial statements show P14.6 billion of benefit expense for YAKAP and Konsulta) and GAMOT P50.7 million.

The statistics do not separate outpatient from inpatient claims, so I can’t say what share of all outpatient spending goes to dialysis. The jump is real in the same series. PhilHealth’s own Stats and Charts show hemodialysis claims paid at P12.6 billion in 2020, P17.4 billion in 2022 and 2023, P28.2 billion in 2024 (5.2 million claims, the figure the news reported) and P71.7 billion in 2025. That is 2.5 times 2024, while all claims paid rose 76% (P164.5 billion to P289.3 billion), so dialysis went from 17% to 25% of the total. Claims rose 39%, so the average per claim went from about P5,400 to P9,900. The documents show the session rate itself rising: P2,600 when 156 sessions a year were introduced (PC2023-0009, June 2023), P4,000 in July 2024 (PC2024-0014) and P6,350 in September 2024 (PC2024-0023), up 144% in about fifteen months. Circulars for 2020 and 2021 allowed 144 sessions. Those changes point the same way as the per-claim rise, but I cannot say how much of it they explain, because the statistics do not say how a claim is counted against sessions, and I could not find a PhilHealth explanation. The first half of 2026 shows P48.7 billion.

How I could be wrong

• I searched the full text of every PhilHealth circular listed on its archive pages for 2019 to 2026 (197 circulars), not only titles, and read the hits in context. It is a search, not a line-by-line reading of every page, and for 21 long scanned documents I read only the first 15 pages. A benefit could still sit in a circular that uses none of the words I searched for. The list and results are in the project repo.
• Some figures come from scanned circulars read by OCR (text recognition). I checked these against page images of the PDFs: the P9,000 GAMOT sandbox limit (PC2023-0029), the hemodialysis rates of P2,600, P4,000 and P6,350 and the 156 sessions (PC2023-0009, PC2024-0014, PC2024-0023), the P1,000 preventive oral health maximum with two visits (PC2024-0034) and the 24-hour limit in the emergency benefit (PC2024-0033). I had already checked the P1,700, P900, P20,000 and 75-drug figures against the documents. The mental health amounts (P9,000 and P16,000) and the P750 and P500 capitation ceilings come from circulars with a text layer. I have not re-checked the 15-test and six-test lists against page images.
• Dates are the dates PhilHealth listed the circulars, not when benefits actually started to be paid.
• I could not read several news pages (blocked sites), and I used only search snippets for those claims.
• I could not find whether the HTAC was ever set up or whether it recommended an outpatient benefit. The circulars cite PhilHealth Board resolutions instead. That could mean it does not exist, or that I didn’t find the record.
• “Comprehensive” is a judgment. The Act does not define it, and PhilHealth may argue the packages already add up to it. I found no PhilHealth statement saying so.
• I’m not a lawyer or a health economist. If I got a circular or number wrong, please comment.

What I’d like to do next

Section 6(b) has no number attached, so “done” is a judgment. I would use three tests. The first can be checked today.

1. Every item on the IRR’s list has a paid benefit. On what I found, palliative care and biologicals (vaccines, insulin) do not, and dental is preventive only.
2. A stated share of outpatient visits is covered. I can’t test this. PhilHealth publishes registrations and first visits, not outpatient visits by who paid.
3. The out-of-pocket outpatient share falls. I can’t test this either. PSA’s out-of-pocket share covers all health spending, not outpatient care alone.

Whichever test you prefer, the data needed are the same: people with a first visit (not registrations), GAMOT users, and spending by benefit, published every quarter. I would ask PhilHealth for those three before anyone calls the benefit done.

Sources

• Republic Act No. 11223 (Section 6)
• Implementing Rules and Regulations (Sections 6.1 to 6.3, 34, 41.7)
• PhilHealth circulars: PC2019-0003, PC2020-0002, PC2020-0022, PC2022-0032, PC2023-0018, PC2023-0029, PC2024-0013, PC2024-0033, PC2024-0034, PC2025-0013, PC2025-0014, PC2025-0017, PC2026-0007; advisories: PA2025-0077, PA2026-0003, PA2026-0018, PA2026-0038
• PhilHealth press releases: YAKAP launch (July 25, 2025); February 12, 2026; May 15, 2026
• GMA News: free medicines under YAKAP (March 12, 2026); GMA News: YAKAP 2.0 (September 2, 2026)
• Philstar: Konsulta capitation raised (March 14, 2024)
• VERA Files (October 10, 2025)
• Philstar: 800 private hospitals (March 13, 2026)
• Manila Times: “PhilHealth: 25% of payouts go to dialysis” (October 3, 2026)
• PhilHealth Stats and Charts 2023, 2024 and 2025; Financial Statements, December 31, 2025 (note 28); PSA National Health Accounts (see part 3)
• Karl Garcia: Mental Health as National Infrastructure (August 28, 2026)
• PhilHealth quarterly monitoring reports to the Governance Commission for GOCCs, 2020–2022; PhilHealth rapid evaluation of Konsulta (August 2022); COA annual audit report on PhilHealth, 2022

The UHC Series

Problem Solving the Philippines: The UHC Series.

• Part 1: What the Universal Health Care Act promises, and who has to deliver it
• Part 2: The study I can’t find, and the rules under the Act
• Part 3: Whose money? The PhilHealth reserve rule, the Supreme Court and the numbers
• Part 4: The outpatient benefit the Act promised within two years (this post)

Lovingly made with Claude.