THE Governance Commission for Government-Owned or -Controlled Corporations (GCG) has approved a sweeping restructuring of the Philippine Health Insurance Corp. (PhilHealth) to adapt it for its expanded role under Republic Act (RA) 11223, or the Universal Health Care Act.
In an en banc meeting held on Wednesday, the GCG gave the green light for the overhaul of PhilHealth’s organizational structure, marking one of the most significant reforms in the agency’s history.
PhilHealth, an attached agency of the Department of Health, manages the National Health Insurance Program.
The restructuring is in response to operational inefficiencies and the growing demands placed on the agency by the Universal Health Care Act.
Under the approved plan, PhilHealth will adopt a new structure comprising 503 organizational units and 7,149 positions. The changes are designed to address long-standing issues such as outdated staffing models, fragmented data systems, inconsistent strategy implementation and delays in benefit claims processing.
Five critical administrative functions — finance, legal, information technology, procurement, human resources and general administration — will be centralized, a move that is expected to eliminate duplication of efforts and improve internal coherence.
To reinforce internal accountability, the GCG also ordered the strengthening of PhilHealth’s internal audit office. The office will now report functionally to the agency’s Board Audit Committee and administratively to its president and CEO, ensuring more rigorous oversight.
A new Benefit Payment Appeals Office has also been created to handle disputes over benefit claims. This dedicated unit aims to speed up the resolution of appeals and improve fairness and transparency in the benefit payment process — an area that has long drawn criticism from patients and health care providers alike.
PhilHealth first submitted its application for restructuring in November 2022. A partial restructuring was approved after a memorandum from the executive secretary called for an in-depth performance review of the agency.
Between May 2023 and January 2025, PhilHealth and the GCG held a series of consultations and submitted additional documents to support the restructuring proposal.
Under RA 10149, or the GOCC Governance Act of 2011, the GCG is mandated to assess whether a GOCC should be reorganized, streamlined, merged, abolished or privatized. It acts as the central advisory and oversight body for the GOCC sector.
PhilHealth has been given one year to implement the key components of the restructuring, including the centralization of services.
The GCG is currently led by Chairman Marius Corpus, with Commissioners Geraldine Marie Berberabe-Martinez and Brian Keith Hosaka. Finance Secretary Ralph Recto and Budget Secretary Amenah Pangandaman serve as ex officio members.
