Left with no other means to pay for her father’s mounting hospital bills, Ozan, a BPO (business process outsourcing) worker, found herself in a line at a local government office with medical records and proof of poverty in hand. She left her father at the hospital, desperate and scared, knowing every minute she spent away could be his last. Yet instead of being by his side, she was in a politician’s office, forced to endure long lines to beg for medical assistance that would extend his father’s life.
After all the humiliation, she received only a few hundred pesos. She was even told to post a Facebook photo thanking the politician. Her father died soon after.
Ozan shared this disheartening and horrendous experience during a press conference,* calling for an end to patronage-driven and for a rights-based health budget. Her story is not an isolated case; it reflects the reality faced by millions of Filipinos afflicted with diseases and stricken with catastrophic health spending.
It appears that, for the poor, attaining healthcare in the Philippines is now a complete circus. Indigent patients seem to have to go through an obstacle course, with one challenge being to beg a politician for a guarantee letter, also called a “GL.” For others who have no one to process their papers, medical treatment is forgone. They resort to self-treatment. Or they tragically die without ever seeing a doctor.
Some patients have had their applications for medical assistance denied after being compelled to move to private facilities due to the overcrowded public hospitals that could not provide them with care.
This is an undignified, humiliating, and, in some cases, deadly health financing system. It favors patronage-driven medical assistance programs over an institutionalized one that channels aid straight to patients. It is slowly and alarmingly becoming the norm. It serves as the new face of pork barrel funds. It keeps people dependent on politicians, as aid must pass through political gates before reaching patients.
Standing between a patient and the aid they desperately need for survival, politicians play the role of a “savior” as if the funds being distributed came straight out of their pocket and not from the national coffer built on every Filipino’s sweat and blood.
What’s even more atrocious is that this kind of health-related ayuda (assistance) is deliberately weakening PhilHealth and universal healthcare. The Universal Health Care (UHC) Act is the institution in place to ensure a rights-based provision of medical assistance.
Under the UHC Act, the Philippine Health Insurance Corp. (PhilHealth) is mandated to provide coverage for all Filipinos through the National Health Insurance Program, ensuring equitable access to quality and affordable healthcare. The law is designed to pool funds from various sources, making PhilHealth the sole purchaser of individual health services.
The membership of every Filipino in PhilHealth entitles him or her to protection from financial hardship. This means that the patient and his or her family members no longer need to leave their hospital beds to visit various government offices or politicians and gather financial assistance.
PhilHealth is being destroyed. While the PhilHealth budget was blatantly zeroed in 2025, the patronage-driven Medical Assistance for Indigents and Financially Incapacitated Patients (MAIFIP) received a staggering P41.15 billion in funding.
PhilHealth’s defunding together with the increase in funding for the Patients MAIFIP shows the government’s lack of appreciation for the essential role of social health insurance in achieving UHC.
For power-hungry, credit-grabbing traditional politicians or trapos, the MAIFIP is preferable to PhilHealth and the UHC. PhilHealth benefits do not have the names of politicians promoted or advertised. The benefits cannot be attributed to the patronage of the politicians.
Over the past decade, there has been a consistent trend of increasing budget allocations for assistance to indigent patients, which later became known as MAIFIP. Historical budget data indicate a concerning increase in medical assistance funds alongside a decrease in PhilHealth funding, particularly evident during the recent midterm election campaign season, under the Marcos administration.
For the 2026 budget, the same situation is set to happen. The House of Representatives is allocating MAIFIP in the General Appropriations Bill (GAB) a total of P49 billion, doubling the Executive’s proposed budget of P24 billion. For an aid that is expected by Congress to reach only 1.27 million Filipinos, as compared to PhilHealth’s 26.15 million indigent patients, such misaligned allocation shocks.
Trapos parade MAIFIP as benevolence, but in reality it reduces people to begging. It relies on political discretion, and it is outright inequitable. The distribution of medical aid under this program depends entirely on the whims of the politician. Whoever receives assistance and how much is granted is left to the politician’s personal favor, inevitably rewarding select beneficiaries while leaving many others with little to none.
According to Dr. Antonio L. Dans, the 2022 National Demographic and Health Survey data reveal a concerning situation: Discretionary health funds disproportionately benefit the better-off. Only 12% of these funds reach the poorest Filipinos, while 43% go to the richest two quintiles. This distribution contradicts what MAIFIP is supposed to be — provide financial assistance to those who are “indigent and financially incapable.” Rather than serving as a safety net for the poor during times of vulnerability, medical assistance through MAIFIP inequitably favors only those that the political patron favors.
The Filipino people are entitled to their right to health. No Filipino should be made to beg or be burdened by utang na loob that turns her suffering into a debt that must be repaid through political loyalty.
Prioritizing MAIFIP over PhilHealth is a betrayal of public service. It is despicable and inhumane.
*The live stream of the press conference on Oct. 3 can be replayed here: https://www.facebook.com/BawasBisyo/videos/756564470671500/?rdid=uPD34DaLYYxbHyhL#
Dhelyn Dela Cruz and Rosheic Sims are researchers and communicators for the fiscal and health policy team at Action for Economic Reforms (AER).