Price negotiation will help determine the prices of drugs to be included in PhilHealth benefit packages. However, these prices, based on my understanding of the JAO, are applicable to providers under the jurisdiction of DOH. As such, providers who are either private or LGU-sponsored may not directly benefit from it. A consolidated/pooled volume will drive … Continue reading Should PhilHealth use the centrally negotiated price of drugs in the development of benefit packages?
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?
"Paying whichever is lower does not change the payment mechanism from ACR to FFS." This is true. Choosing to pay whichever is lower will not automatically change the payment mechanism from All Case Rates (Case-based payment) to Fee-for-Service. The "change" in payment mechanism does not depend on how we choose to pay, but on what … Continue reading Bill vs. ACR: Should the government pay for whichever is lower?
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
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
Various provider payment mechanisms will continue to exist in the country’s health care system. Emphasis is placed, however, on the current movement towards using performance-driven, prospective payments (e.g. Global Budget Payment) based on diagnosis-related groups (DRG). The shift to DRG-based GBP will not be easy. Mechanisms should be in place to avoid underprovision and ensure … Continue reading Pen Point 49