PIDS EPM 2020-2021
Reset and Rebuild for a Better Philippines in the Post-pandemic World
DLSU-AKI Working Paper Series 2021-11-079
Examining and Evaluating the Multidimensional Energy Poverty Index (MEPI) in the Philippine Household Context
DLSU-AKI Working Paper Series 2021-11-078
A Game Theoretic Study on CSR and Government Intervention for Sustainable Production
DLSU-AKI Working Paper Series 2021-11-077
Obstacles to Economic Freedom Affecting Micro, Small, and Medium Enterprises (MSMEs) in Southeast Asian Countries

PIDS WB 2021-1104
Assessing the Philippines' Performance in Meeting the ASEAN Economic Community Vision 2025
PIDS WB 2021-1103
Examining The Health Impacts Of The COVID-19 Pandemic In The Philippines
ILS 30th Anniversary Video
PIDS WB 2021-1102
Evaluating the Pantawid Pamilyang Pilipino Program's Payment System
Publication Detail
DP 2014-42: Reconnaissance Study on the Implementation of Case-Based Payments

To improve PhilHealth`s benefits framework, enhance hospital services, and achieve one of the Universal Health Care`s thrusts, greater financial protection, the case-based payment (CBP) scheme was implemented in 2011. CBP is a provider payment scheme initially implemented with rates for the 23 most common medical and surgical cases. This study investigates what has happened with CBP after its nationwide implementation through the perspectives of the following stakeholders, such as PhilHealth, administrators of health facilities, and health care providers. This also concerns operational aspects of the implementation not an assessment whether CBP helped achieve Universal Health Coverage for the Philippines. The approach used in this study is a mix of qualitative methods including desk review of the legal framework of health financing, administrative orders related to CBP, key informant interviews, and survey on health care providers. Areas of implementation were thematically grouped into four categories based on the results of interviews and survey, namely: 1) administration and system, 2) human resources, 3) medical integrity, and 4) financing.

Overall, CBP needs improvement on the turnaround time for reimbursements to both health providers and hospitals, electronic updating of claims, membership directory, and physicians` accreditation statuses, shifting of policies from different implementing agencies, transparency, and impact evaluation processes for health outcomes.

Philippine Institute for Development Studies
Authors Keywords
Dalmacion, Godofreda; Juban, Noel R.; Zordilla, Zenith; Philippines; PhilHealth; case-based payment; financial protection;
Download PDF Number of Downloads
Published in 2014 and available in the PIDS Library or Downloaded 1,304 times since December 18, 2014
Please let us know your reason for downloading this publication. May we also ask you to provide additional information that will help us serve you better? Rest assured that your answers will not be shared with any outside parties. It will take you only two minutes to complete the survey. Thank you.

To use as reference:
If others, (Please specify):
Name: (optional)
Email: (required, but will not display)
If Prefer to self-describe, please specify:
Level of Education:
If employed either part-time or full-time, name of office:
If others, (Please specify):
Would you like to receive the SERP-P UPDATES e-newsletter? Yes No
Use the space below if you have any comment about this publication or SERP-P knowledge resources in general.