The Philippines offers an encouraging array of privileges for citizens aged 60 and above — in some respects more generous than many other countries when it comes to retail perks. A Filipino who turns 60 becomes entitled to a 20% discount and VAT exemption covering medicines, medical services, transport, restaurants, hotels, and other purchases. Additional support includes mandatory PhilHealth benefits, social pensions for indigent seniors, local government assistance programs, and cash gifts for the very old. On paper, the country appears to care deeply for its elderly population.

Yet discounts alone do not constitute a care system, and that is precisely where the Philippines falls short. Periodic medical tests and maintenance medications can be prohibitively expensive; without private health insurance, medical bills can reach staggering levels even with PhilHealth assistance. A senior discount can reduce the price of medicine or a medical service, but it cannot help an elderly person bathe, eat, walk, remember their medication, or cope with dementia. A VAT exemption can make a restaurant meal cheaper, but it provides no economic relief to a family member who has left the workforce to care for a bedridden parent. PhilHealth helps cover hospitalization, diagnostic tests, checkups, and medicine, but it does not yet function as a national long-term care system addressing frailty, disability, home care, or nursing support for a growing elderly population.

Senior benefits in the form of discounts and tax privileges should not be mistaken for an effective state aging policy. That confusion becomes more hazardous as the government weighs changes to PhilHealth that would reward paying contributors with enhanced benefit packages.

Executive Secretary Ralph Recto has been advocating since the start of the year for paying members — particularly the middle class — to receive expanded PhilHealth benefits proportional to their contributions. His reasoning, as he has stated, is that someone paying P50,000 to P60,000 annually currently receives the same base coverage as someone who pays nothing, and that contributing members deserve more for that difference.

PhilHealth has stated that indigent and non-paying members will retain their existing benefits regardless of the outcome. That is a fair and necessary assurance, though it does not resolve the underlying concern. If paying members begin receiving meaningfully better hospital rooms, faster service, and richer coverage packages while the base tier remains unchanged, the country effectively creates two classes of care within a single public insurance system. While less visible than an outright benefit cut, such a shift still moves PhilHealth away from the spirit of universal health care — the principle formally enshrined in Republic Act 11223, the Universal Health Care Act signed into law in 2019, which mandates automatic PhilHealth enrollment for all Filipino citizens and direct provider payment mechanisms designed to ensure equitable access regardless of contribution level.

This development would be especially dangerous for indigent seniors and even for middle-class elderly Filipinos. Wealthy individuals can self-insure and afford premium care regardless of any tier structure. But the middle class and poor seniors — even under a system like the one Recto describes — generally lack the capacity to sustain adequate long-term care independently. The poorest elderly Filipinos are the people least equipped to contribute, least able to purchase private insurance, least able to hire caregivers, and most vulnerable to being left without support as families struggle to cope. A health financing model that gives more to those who contribute more may ease middle-class frustration, but it risks undermining the principle that should guide an aging society: the people who need care most are often those least able to pay for it.

The Philippines therefore needs a more substantive national conversation about long-term aging care — one that goes beyond discounts and hospital insurance. The central question is whether the country is prepared to finance the actual needs of old age: home assistance, caregiver support, dementia supervision, mobility help, nursing care, rehabilitation, respite care, and dignified end-of-life support.

Health insurance alone is insufficient because old age is not solely a medical condition — it is a care condition. A person may not require surgery or hospital confinement yet still need daily assistance simply to live. Long-term care insurance, designed for people who have difficulty caring for themselves, particularly those with sustained or severe disabilities, could address this gap. Such a program could pay for services or, in some cases, provide direct financial support covering help with bathing, feeding, toileting, dressing, grooming, basic nursing, rehabilitation, home care, and institutional care for those who pass a disability assessment.

China offers one model worth examining. Rather than beginning with a universal benefit for everyone over 60, it started with the group in greatest need: people who have lost the ability to perform basic daily tasks. Financing is structured by contribution category. Employed workers share contributions between employer and individual, collected alongside regular medical insurance premiums, with a modest overall rate reportedly kept around 0.3% of income. Retirees contribute individually. Unemployed urban and rural residents are financed through a combination of personal contributions and government subsidies. The insurance pays qualified care providers directly rather than disbursing cash, and eligibility requires a professional assessment of the applicant's disability or functional limitations.

Building on pilot programs launched in 2016, enrollment in China's long-term care insurance has reportedly reached roughly 310 million people nationwide, with several million individuals with disabilities already receiving bedside assistance with bathing, grooming, eating, and dressing. The program has also reportedly reduced pressure on hospitals and household finances while fostering a new care economy comprising certified caregivers, home-care agencies, nursing facilities, and rehabilitation providers. China is not simply offering its seniors another discount — it is financing the care work that families have historically absorbed quietly and invisibly, transforming a private family burden into a shared social responsibility funded in advance and disbursed through actual care services. Japan, which launched its own mandatory long-term care insurance system in 2000, and South Korea, which followed with a similar program in 2008, offer additional reference points — each designed in response to rapid demographic aging that had already begun straining families and hospitals.

The Philippines is not yet as demographically old as China, Japan, South Korea, or Thailand. According to the 2020 census, Filipinos aged 60 and above numbered roughly 9.2 million, or about 8.5% of the population — a share projected to rise steadily in the coming decades. That is not a reason for delay — it is an opportunity. Countries typically construct long-term care systems only after family caregiving has already begun to collapse, hospitals have become congested, and public finances are strained. The wiser approach is to build the system before the crisis arrives, not after.

A 20% discount at the pharmacy counter is welcome, but it was never going to be the mechanism that keeps someone fed, bathed, and dignified in their final years. The Philippines has senior-citizen benefits. What it does not yet have is a serious aging-care system. That is the gap the country should begin closing now, while there is still time to build it before the need becomes critical.

Marvin Tort is a former managing editor of BusinessWorld and a former chairman of the Philippine Press Council. (matort@yahoo.com)