This definition of "overpayment" in the context of FFS is outright wrong. We are accustomed to thinking that paying a peso for every peso is the only right thing to do in a country that is deluged by cases of graft and corruption. Our past has conditioned us to think that paying over or under … Continue reading Is the government paying more than it should?
Efficiency gains should NOT be criminalized because they encourage the health care system to provide the best care we all deserve. At one point in time, HCPs paid under the ACR system will achieve efficiency gains by decreasing the overall cost of health care. HCPs do this by meticulously deciding on what and what not … Continue reading Should the government “criminalize” efficiency gains?
Paying for amounts printed on receipts is tantamount to subscribing to FFS rather than ACR. As illustrated above, this is inefficient and could likely promote external fraud. ACR, however, is far from perfect but averaging should've been the best method to determine the average cost of care needed for a specific case or procedure. The … Continue reading Should the government pay for whatever is on the receipt?
I agree that PhilHealth, as the implementer of the NHIP, should continue providing FP to all Filipinos by reimbursing claims. PHILHEALTH SHOULD NOT DENY CLAIMS JUST SO IT CAN PRESERVE FUNDS and have a longer actuarial life. IMHO, PhilHealth's role as a strategic purchaser of healthcare services/goods is the fulcrum that balances the health and … Continue reading Government should provide financial support to PhilHealth
During the Committee Hearing on August 17, Marikina Rep. Quimbo was surprised to know that hospitals are allowed to use funds from the Interim Reimbursement Mechanism (IRM) for other operational expenses (e.g. salary). Let me reiterate that the same mechanism is expected when "prospective payments" (in the form of global budgets) will be provided to hospitals … Continue reading Principle behind IRM is good
I get our anger and frustration over the issue. But the claims forms (CF1, CF2, CF3, CF4) are not there to make it "easier" for PhilHealth to pursue corrupt practices. Actually, the forms are there to safeguard the interests of PhilHealth members by allowing the hospital to declare that the standards of care have been … Continue reading On the corruption allegations against PhilHealth
How do we shape a future with no one left behind? In many countries, health technology assessment (HTA) is a relevant consideration for the distribution of limited resources and is used to decide whether a health technology should be reimbursed or not. In the Philippines, under the Universal Health Care (UHC) Act, only health technologies … Continue reading #NoOneLeftBehind: Modify the HTA process for rare diseases
With limited manpower and resources, hospitals can only do so much in a pandemic. Sadly, the country is still in the pandemic phase of the COVID-19 outbreak and more cases are expected to be confirmed in the following weeks. The Department of Health (DOH) has recently identified six areas in the Visayas as emerging COVID-19 … Continue reading Stepwise Approach to Address the Nursing Shortage in Critical Care Settings
PhilHealth has instituted a no copayment policy for its benefit packages for the diagnosis and management of COVID-19. The costing of these benefit packages is a result of an iterative process involving data collection, stakeholder consultations, and data analysis. As such, we can say that the “maximum” health care cost for a specific service (e.g. … Continue reading PhilHealth should provide incentives to eliminate out-of-pocket expenses
What mechanisms are available to fund the pandemic response? The Ebola crisis in West Africa in 2014 highlighted the difficulty in rapidly organizing funding for an outbreak, especially among economically vulnerable countries. To address this and to prevent future financial catastrophes, several financing mechanisms have been presented to countries. These mechanisms aim to fund the … Continue reading Pandemic Financing: How the World is Funding the COVID-19 Response (Part 3)