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No Margin Left
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The covered part, the paid part, and whether the chair is even there

What the safety net leaves you

Pick a catastrophic condition and model the bill it presents in the Philippines: what PhilHealth's case rate absorbs, the gap you pay against a typical private bill, and — the part the brochures never show — how few facilities exist to treat it. This prices a tariff gap for a scenario you choose to inspect. It is population and tariff data, never a prediction about you.

The scenario to model
Condition to model
PhilHealth enrolment
A foreigner who never enrolled is covered for nothing — the case rate applies to members only.
Dialysis detail — edit these
A disclosed, contested assumption. PhilHealth's benefit release cites up to 156 sessions/year; its benefits page implies a 90-day limit. The tool shows both ends rather than hard-coding one — the ceiling, not the rate, is the exposure.

The gap is only half the problem; whether the care is physically near you is the other. The capacity figures appear with the result.

Model only — the case rates and capacity counts are ledger reads; the private bill is an editable illustrative default cross-referenced from the pieces below, not a live quote. Read them:

Methodology & sources — the short version

For a per-case condition (stroke, bypass), PhilHealth's case rate caps the cover and you pay the rest; for dialysis, the case rate is paid per session up to an annual ceiling, so within the ceiling an enrolled member's dialysis is largely covered and the sessions beyond it are self-pay — the ceiling is the exposure, not the rate. A foreigner who never enrolled pays the whole bill either way.

Dated anchors — case rates and capacity are sourced; the private bill is editable:

  • PhilHealth case rates: haemodialysis ₱6,350/session, ischemic stroke ₱76,000/case, CABG ₱660,000–960,000 (a band by procedure). From the case-rate ledgers.
  • Capacity: 959 accredited freestanding dialysis clinics in 364 of 1,642 municipalities (1,278 have none); 3,096 adult ICU beds nationally (2.7 per 100,000). From the capacity ledgers.
  • Private bill defaults are illustrative, cross-referenced from the article traces (a Cardinal Santos open-heart package around ₱1.2–1.4M; private haemodialysis ₱2,500–5,000/session) — not a live quote, and the Philippines has no single published private ischemic-stroke admission price, so set your own.

The full trace is in this site's source file for this tool (content/data/philhealth-gap.yml); the ledgers are open data under /data.