ASEANEWS HEADLINE- HEALTH | MANILA, Philippines: No more need for health aid ‘guarantee letters’

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Herbosa: Public doesn’t need guarantee letters from politicians to receive medical assistance | ANC

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MANILA, Philippines — The 2026 national budget law disallows direct intervention by politicians in giving indigent patients access to health services, including through guarantee letters, starting this year, Health Secretary Teodoro Herbosa said on Wednesday.

In a briefing at Malacañang, Herbosa said that indigent patients would not need guarantee letters (GLs) from congressmen, senators, and other officials to cover their expenses for health services under the Zero Balance Billing (ZBB) Program of the Department of Health (DOH).

READ: DOH to implement zero balance billing in selected LGU hospitals

GLs will be prohibited, at least in government hospitals, from availing themselves of the Medical Assistance to Indigent and Financially Incapacitated Patients (Maifip) program starting this year, he said.

“The law actually prohibits a guarantee letter,” Herbosa said. “The law is very clear and we will follow the law.”

He said the DOH would release updated implementing rules and regulations for Maifip by February in compliance with the “anti-epal” provision cited by President Ferdinand Marcos Jr. in this year’s national budget.

Under Section 19 of the 2026 General Appropriations Act (GAA), all cash assistance and other forms of financial aid shall be distributed exclusively by authorized government officers and personnel or accredited partners.

“No public officials holding elective positions, electoral candidates, politicians, political parties, or any of their representatives, except for officials having direct administrative and executive authority over the implementing agency, shall influence, be present in, participate in, or take part in the actual distribution of any cash assistance and other forms of financial aid,” the provision states.

“No political signage, branding, paraphernalia or activity shall be displayed or conducted within the distribution area,” it adds.

When he signed the GAA last Monday, Marcos himself served notice to politicians that they would be “barred from the distribution of any financial aid, and we shall ensure that the support reaches the intended beneficiaries without patronage.”

Under the ZBB program, patients admitted to DOH hospitals are no longer required to pay for medical services, medicines, and doctors’ professional fees, as long as they are confined in basic or ward accommodations.

“The reason we implemented zero balance billing is so that there’s nothing left for them to pay—you don’t have to go through politicians,” he said.

Herbosa clarified that patients are not prohibited from seeking assistance from their elected officials. However, GLs issued by politicians are no longer necessary under the ZBB program.

“They can go straight to the Department of Health and we will help them if they need help and if we have the funds, we will provide the funds if they are qualified to get the funds,” Herbosa said.

A guarantee letter from a government official or agency is addressed to a health service provider, giving it an assurance of full or partial payment for the service provided to a beneficiary.

Under DOH Administrative Order (AO) No. 2025-011, which is still in effect, GLs remain a form of aid for Maifip beneficiaries who want to reduce their hospital bills or other expenses in private facilities, as well as hospitals operated by local government units and state universities and colleges.

25-percent increase

GLs, however, will still be honored in health facilities until a new AO on Maifip is issued.

Herbosa said that politicians may still issue GLs, but they should shoulder the medical expenses of their beneficiaries without using Maifip funds.

Maifip received P51.6 billion under the 2026 GAA, a 25-percent increase from last year’s P41.16 billion.

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It is at par with the P53.13-billion government subsidy for the Philippine Health Insurance Corp. (PhilHealth) this year.

The fund for indigent patients began in 2014 as the Medical Assistance to Indigent Patients in Government Hospitals and was renamed as Maifip in 2016.

Health advocates and some lawmakers said that it had become a health “pork barrel” fund that was fueling patronage politics, principally through the guarantee letter system.

Critics say that it had turned a human right into a political favor where the poor regard the treatment of their illnesses as a debt of gratitude to politicians rather than a service they deserve as citizens.

Others say that Maifip undermines the Universal Health Care (UHC) Act by drawing funds away from PhilHealth.

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Sen. JV Ejercito, author of the UHC law, proposed a gradual abolition of the controversial health aid fund “because the UHC and PhilHealth are becoming more effective.”

Some beneficiaries are keen on moves to defund Maifip amid the criticisms.

Rey Abacan Jr., president and founder of patients’ group Dialysis PH Support Group Inc., said Maifip was a “band-aid” solution to the high cost of health care in the country, and getting GLs just to avail of its benefits was both difficult and degrading.

‘Fix the system’

But giving all of Maifip’s budget to PhilHealth at this time won’t be good either because the state health insurer’s coverage isn’t sufficient, he said.

There are hospitals where your bill may reach P100,000 but PhilHealth will only cover P5,000. That is when “you can use a guarantee letter,” he said.

“It’s better to fix the system before we slowly remove the guarantee letters. Maybe we should focus first on fixing what PhilHealth lacks. Improve the packages first, and then we can slowly phase out the GLs,” he said.

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Abacan said he was a college student when he was stricken by stage 5 chronic kidney disease and started undergoing dialysis in 2010. Back then, PhilHealth could cover only 45 sessions per year.

It was a struggle to save money, which was also needed for transportation, dialyzers and medicines, he told the Inquirer.

Long queues

To pay for the expenses not covered by PhilHealth, Abacan got GLs from senators and congressmen, and the Philippine Charity Sweepstakes Office (PCSO) every three months, which at that time covered expenses amounting to P40,000 to P60,000.

But to get those letters, Abacan, who is from Bulacan, said he needed to endure long queues at the PCSO office in Quezon City and the Senate in Pasay City.

“When I started undergoing dialysis, you had to line up the night before, because once they run out of slots, you would not be given [a guarantee letter],” he said.

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Nowadays, Abacan said some senators and congressmen have started accepting applications for GLs online, making it easier for patients like him.

But the guarantee letters were now typically worth less, sometimes ranging around P3,000 to P5,000, because of the numerous applicants.

“In our community of dialysis patients, guarantee letters are a big help,” he said. “But the system, I can say, is old or not applicable, because like the issue now, it is being used for politics,” he said, adding that applying for GLs was like begging.

“It is painful for the patient. Think of it—you are already sick, but you still have to beg,” he said.