No Balance Billing (NBB) policy in the Philippines

 

Origins and Early Implementation (2011–2012)

• 2011: PhilHealth introduced a new case-based payment system (also known as per-case payment), accompanied by the No Balance Billing (NBB) policy. Under NBB, indigent and sponsored members were protected from paying any fees beyond the PhilHealth package rates. This initially applied to a limited number of medical cases and procedures—23 were included at the start. Government hospitals were mandated to implement this starting September 1, 2011, via PhilHealth Circular No. 011-2011.E-LibraryPCHRDPhilstar

• January 19, 2012: Media reports confirmed that government hospitals had begun enforcing the NBB scheme based on this circular.Philstar

Therefore, the NBB policy effectively began in 2011, with formal nationwide application being implemented in late 2011 into early 2012.

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Legal Reinforcement and Extension (2013–2014)

• 2013: Republic Act No. 10606 (the National Health Insurance Act of 2013) was enacted. Article 43 of its implementing rules and regulations codified NBB by stating that no additional fee may be charged to indigent patients beyond what PhilHealth covers.E-LibraryPCHRD

• January 9, 2014: PhilHealth issued Circular No. 003, s. 2014 to strengthen and improve enforcement of the NBB policy, reaffirming that no additional charges are allowed for indigent patients beyond PhilHealth’s case rates.E-LibraryJur

• June 2014: PhilHealth extended NBB to include “kasambahays” (domestic workers), ensuring they’ll also not be charged above PhilHealth’s benefit when hospitalized in government facilities.PhilHealth

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Broader Expansion (2019–2025)

• 2019: Under the Universal Health Care (UHC) Law (Republic Act No. 11223), the NBB principle evolved into a broader “no co-payment” concept. It expanded coverage to all patients availing of basic (ward) accommodation in both government and private hospitals, thereby extending financial protection beyond indigents.PCHRD

• July 2025: The Department of Health (DOH) clarified that the updated NBB (no co-payment) implementation covers only the 87 DOH-run hospitals, excluding GOCC-operated facilities such as the Philippine Heart Center, National Kidney and Transplant Institute, Lung Center, and Children’s Medical Center—for now.Philstar

PhilHealth source materials further confirm that the zero-balance policy has been in effect since 2011, initially limited to indigent patients, and has since been broadened in recent years.PhilstarRedditPCHRD

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Summary Timeline

✅ Fact: NBB has been in the Philippines since 2011:

• 2011: PhilHealth introduced NBB for indigent patients under Aquino (PhilHealth Circular No. 011-2011).

• 2013: Law codified under RA 10606.

• 2014: Strengthened by PhilHealth Circular No. 003, expanded to kasambahays.

• 2019: UHC Law under Duterte expanded NBB to “no co-payment” in basic accommodations.

• 2025: Marcos Jr.’s administration is continuing enforcement, but did not create the policy.

💡 Bottom line: NBB is a long-standing law that predates PBBM. Current reports are about implementation, not creation.

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Additional Insights

• Coverage has gradually expanded from indigent individuals toward broader categories like sponsored members, kasambahays, and eventually all PhilHealth members using basic accommodations under the UHC reforms.

• Nonetheless, gaps and challenges remain—such as partial implementation in public hospitals, exclusion of GOCC facilities, and occasional supply issues.PCHRDReddit+2Reddit+2

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The No Balance Billing (NBB) policy began in 2011, enacted alongside PhilHealth’s shift to a case-based payment system. It was legally reinforced by the 2013 National Health Insurance Act (RA 10606) and formally strengthened by PhilHealth Circular No. 003 issued on January 9, 2014. Over time, its coverage extended—from indigent patients to include sponsored members, kasambahays, and eventually, basic-ward patients under the Universal Health Care law. As of mid-2025, its enforcement currently covers 87 Department of Health hospitals, with plans to eventually include other government health facilities.

✅ Why some are attributing NBB to PBBM

1. Recent Announcements (2025):
   In July 2025, the Department of Health (DOH) clarified that NBB (or no co-payment) applies in 87 DOH-run hospitals. This was reported widely in the news and timed during PBBM’s presidency. Many people thought this was a new program under Marcos Jr., rather than a continuation of an older policy.
   (Source: Philstar, July 30, 2025)

2. Political Framing:
   Troll networks often highlight ongoing government programs as though they were brand-new initiatives of the sitting president. Since healthcare is a sensitive and popular issue, presenting NBB as “PBBM’s project” can generate approval and bolster political credit.

3. Public Confusion:
   Many ordinary citizens only became aware of NBB recently, especially when media outlets reported about free hospitalization in DOH hospitals. Without knowledge of the 2011–2014 history, they might assume it was newly created by the current administration.

The NBB policy long predates PBBM’s administration:

• 2011 (Aquino administration):
  NBB was introduced by PhilHealth Circular No. 011-2011 alongside the case-based payment system. Indigent and sponsored members in government hospitals were the first beneficiaries.
  (Source: PhilHealth Circular 011-2011)

• 2013 (Aquino):
  RA 10606 (National Health Insurance Act of 2013) codified the NBB policy in law.
  (Source: RA 10606, Section 43)

• 2014 (Aquino):
  PhilHealth Circular No. 003, s. 2014 was issued to strengthen NBB implementation. Kasambahays (domestic workers) were later included.
  (Source: PhilHealth Circular 003-2014)

• 2019 (Duterte):
  The Universal Health Care (UHC) Law, RA 11223 expanded NBB into a “no co-payment” scheme in basic accommodations for all Filipinos.
  (Source: UHC Law)

• 2025 (Marcos Jr.):
  The DOH clarified that the existing NBB/no co-payment applies only in 87 DOH hospitals. This is not a new invention, but a continuation of the law passed years before.
  (Source: Philstar, July 2025)

Government Trolls Claim: NBB started under PBBM.
Fact: NBB started in 2011 under the Aquino administration, was strengthened in 2013–2014, expanded by the 2019 UHC Law under Duterte, and is merely being implemented further during Marcos Jr.’s term.

Thus, while PBBM may currently be enforcing or publicizing the policy, he did not create it.