Publications

PN 2016-05Optimizing PhilHealth's Case-based Payment Scheme to Achieve Greater Financial Protection
Dalmacion, Godofreda V., Juban, Noel R., Zordilla, Zenith

In 2011, PhilHealth implemented the case-based payment (CBP) scheme to improve its benefit framework, enhance hospital social services, and achieve greater financial protection for its patients. The CBP is observed as better than the fee-for-service system as it has shortened the turnaround time of reimbursement to facilities from six months to two months during the first six months of implementation. Hospital administrators and physicians conclude, however, that the CBP needs to further shorten the turnaround time for reimbursements to both health-care providers and hospitals. This Policy Note proposes the adoption of a mixed provider payment scheme instead of one mechanism, and an economic evaluation to determine if the cost for a treatment/procedure is not only financially fair but also effective and inclusive to all socio-income groups.

keywords:Philippines, PhilHealth, health sector, health-care financing, case-based payment scheme, health care, provider payment mechanism
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