AT A time when prices seem to rise faster than paychecks—when every trip to the market, every fuel stop, every electric bill feels heavier—many Filipino families are learning a hard lesson: one hospital visit can undo years of hard work. In times like these, one thing becomes painfully obvious—healthcare should never be a luxury.
That was the promise behind the government’s Zero Balance Billing (ZBB) policy: no Filipino should walk out of a public hospital burdened by medical debt. For many, especially the poorest among us, that promise has meant relief, even survival. But for a long time, ZBB was seen as a safety net meant only for those at the very bottom.
Now, that thinking is beginning to change—and it couldn’t come at a better time.
Recent calls from government leaders, including Executive Secretary Ralph Recto, to extend the real benefits of ZBB to the middle class signal an important shift. At last, the conversation acknowledges a group often overlooked in social programs: ordinary working Filipinos who pay taxes faithfully, contribute to PhilHealth every month, and yet are only one medical emergency away from financial ruin.
Since ZBB’s nationwide rollout in mid-2025, its impact has been undeniable. In government hospitals, patients confined in basic or ward accommodations have been able to go home without paying for room charges, procedures, medicines, or doctors’ fees. For more than a million Filipinos, that meant leaving the hospital focused on recovery—not on how to pay the bill.
This is what a functioning public health safety net looks like. It shields families from medical impoverishment—the quiet tragedy where a single illness forces parents to borrow endlessly, sell property, or pull children out of school just to stay afloat.
And yet, ZBB’s success has also exposed a lingering inequity in our healthcare system.
For decades, social protection in the Philippines has rightly focused on the poorest and most vulnerable. But somewhere along the way, the middle class—the teachers, nurses, office workers, small business owners—fell through the cracks.
These are families who don’t qualify as indigent, but who are far from wealthy. A major surgery, a cancer diagnosis, or a prolonged hospital stay can still cost hundreds of thousands of pesos. Insurance and PhilHealth help, yes—but often not enough. Savings disappear. Loans pile up. Stability evaporates.
This is the reality for millions of Filipinos who are “earning enough” on paper but are financially fragile in real life. When healthcare costs force people to delay treatment, skip check-ups, or choose between medicine and groceries, the system is failing—regardless of income bracket.
If the middle class is the backbone of our economy and tax base, then extending them meaningful healthcare protection isn’t charity. It’s fairness.
Making ZBB more inclusive is not only the right thing to do—it makes economic sense. When families are spared crushing medical expenses, they can keep spending, saving, and contributing to the economy. When illnesses are treated early, the state avoids the far higher costs of advanced, complicated care.
The government has already shown it understands this. Funds have been allocated to expand ZBB to more hospitals, including those run by local governments, and to strengthen specialty care. The return of unused PhilHealth funds has also opened the door to a broader, more sustainable healthcare safety net.
What’s needed now is the political will to make inclusivity the rule, not the exception. And yes—accountability matters.
Of course, none of this works without integrity.
Filipinos have every reason to be skeptical. Too often, public funds meant for health end up wasted, delayed, or lost to corruption. Too often, access to assistance has depended on who you know, which politician’s signature you can get, or which office you can beg for a “guarantee letter.”
Healthcare should never be a favor handed out for loyalty or publicity. It is a right, funded by taxpayers, and it must be delivered transparently and efficiently. Every peso lost to corruption is a peso taken from a patient who needs medicine, a bed, or a fighting chance to live.
Zero Balance Billing is one of the most hopeful healthcare reforms in recent years. But its promise will only be fulfilled when it recognizes a simple truth: financial vulnerability does not stop at poverty.
Every Filipino—whether a jeepney driver, a call center agent, a public-school teacher, or a market vendor—deserves access to care without fear of financial collapse. Our taxes should come back to us not as red tape or broken promises, but as dignity, security, and the assurance that when illness strikes, we are not alone.
Affordable healthcare for all is not an abstract ideal. It is a measure of who we are as a society and whether we choose to protect people, or leave them to fend for themselves when they are most vulnerable.
