Philippines

The country’s clamor for more comprehensive health insurance in terms of population coverage and benefits led to the passage of the National Health Insurance Act of 1995. It paved the way for the creation of the Philippine Health Insurance Corporation (PhilHealth) to provide health insurance coverage and ensure affordable, acceptable, available, and accessible health care services for all citizens of the Philippines. This social insurance program serves as the means for the healthy to help pay for the care of the sick and for those who can afford medical care to subsidize those who cannot.

The first years of PhilHealth aimed at improving health care benefits and expanding coverage to marginalized sectors.

In 2004, improved accreditation requirements were introduced for healthcare facilities and when the “Benchbook” was introduced—the yardstick for assessing the quality of care delivered by the healthcare providers. Also at this time, additional revenue was earmarked for health over five years from taxes on alcohol and tobacco products.

In 2013, the program was again amended, further strengthening coverage of the indigent and informal sectors. The amendment also paved the way for a shift in the provider payment mechanism from fees for services to case-based payments. This year also saw extended subsidies from additional tax revenues from the Sin Tax Law.

In 2019, the Universal Health Care Act was enacted into law with the goal to harmonize existing, yet fragmented, health care programs of key agencies and stakeholders, streamline financial resources, expand primary care benefits, and reduce out-of-pocket health care costs to advance the goal of universal health care in the country.

Data Analytics for Monitoring Provider System.

The effective and efficient processing and use of data is a vital requirement for PhilHealth to achieve its mandate of providing financial risk protection for all Filipinos, especially with the recent passage of the Universal Health Care Law.

PhilHealth envisioned optimal data management and use practices across its core business process, and the achievement of this vision has commenced with its new Business Intelligence solution, where traditional barriers to efficiency, information accessibility, and collaboration have started to be broken down. With valuable insights made possible by performance dashboards, there will be an assurance of singularity and integrity of mission-critical data, system and process harmonization, and ease of data access and availability that are keys to PhilHealth’s survival and success. The transformation has already resulted into ground-breaking decisions and initiatives, and will eventually reshape the decision-making mindset and process across the institution.

With the implementation of business intelligence and analytics in PhilHealth, key performance indicators with regards to efficiency have become measurable and are easily analyzed. Target setting is achieved through proper identification of achievable goals via information extrapolated and discussed with different entities within the PhilHealth. Performance is measured on a daily basis initially using elemental indicators such as turn-around-time (TAT) that encapsulates how fast a particular region processes claims. Other indicators, such as collection efficiency, cover how the organization functions and envisions how it provides public services to the Filipino people. With the implementation of more advanced analytics in the pipeline, PhilHealth will be able to analyze data and better mitigate fraud.