A Comparative Analysis of PhilHealth Reimbursement for Common Illness Claims in Selected Government and Private Hospitals in Albay
DOI:
https://doi.org/10.5281/zenodo.19924754Keywords:
common illness claims, government hospitals, private hospitals, health insurance, PhilHealthAbstract
The National Health Insurance Act of 1995 created the Philippine Health Insurance Corporation (PhilHealth), a government-owned and -controlled corporation (GOCC) under the Department of Health, with the mandate to provide health insurance coverage and ensure that healthcare is affordable, acceptable, and accessible to all Filipinos. Both government and private hospitals share this responsibility but differ in the extent to which they utilize PhilHealth benefits, leading to variations in hospitalization claims. This study examined and compared PhilHealth hospitalization payments for common illness claims, timeliness of claims processing, and adequacy of coverage in selected government and private hospitals in Albay using quantitative data sourced from the PhilHealth database. Findings revealed that a government hospital classified as Category A performs at par with private hospitals in terms of PhilHealth payments, though significant variances in claims exist due to differences in claimant access, hospital resources, and service utilization. Factors such as the availability of medical personnel, facilities, hospital reputation, and infrastructure also shape patients’ choices and influence the patterns of PhilHealth hospitalization claims.
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References
2022; Joint-Circular/Revised-Organizational-Structure-and-Staffing-Standards-for-Level-III-General-Government-Hospitals. www.dbm.gov.ph
Admin, S., & Admin, S. (n.d.). National health insurance program (NHIP)-SDGs-philippines. SDGs-Philippines- https://sdg.neda.gov.ph/national-health-insurance-program-nhip
Allianz. (n.d.) Healthcare in the Philippines | Philippines Health Insurance .allianzcare.com.
Alvin B. Caballes, Walter Sollner, Juan Nañagas (2012). Financial protection mechanisms for inpatients at selected Philippine hospitals. ScienceDirect. Volume 75, Issue 10, November 2012, pages 1820-1827
Aparece, JP and Lam, et.al, (2023). Trends and Demographics in Heart Failure Hospitalizations in the Philippines from 2014 to 2022. Available at SSRN: https://ssrn.com/abstract=4699187 or http://dx.doi.org/10.2139/ssrn.4699187
Bernadette A. Tumanan-Mendoza MD, Victor L. Mendoza MD, Felix Eduardo R. Punzalan MD, Paul Ferdinand M. Reganit MD, and Silverose Ann A. Bacolcol MD (2015). Economic Burden of Community-Acquired Pneumonia among Adults in the Philippines: Its Equity and Policy Implications in the Case Rate Payments of the Philippine Health Insurance Corporation. ScienceDirect. Volume 6, May 2015. Pages 118-125
Blake Warren Ang and Lenora Fernandez. A prospective study on direct out-of-pocket expenses of hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease in a Philippine tertiary care center. Springer Nature Link. Volume 24, Article number 184 (2024)
Bredenkamp, C., & Buisman, L. R. (2016). Financial protection from health spending in the Philippines: policies and progress. Health Policy and Planning, 31(7), 919–927. https://doi.org/10.1093/heapol/czw011
Cabato, L. (2024, January 14). PhilHealth members’ contribution hikes to 5% this 2024. INQUIRER.net
Cacciata, M., Alvarado, I., Jose M., and Evangelista, L., (2021 Jan 31). Health determinants and risk factors for coronary artery disease among older Filipinos in rural communities. PMCID: PMC8324596
Cairncross, Carrie-Anne & Moabelo, Martin & Willie, Michael & Kabane, Sipho. (2013). Out-Of-Pocket Expenditure by Beneficiaries of Medical Schemes: 2013-2019.
Cervantes, F., (April 23, 2021). Go directs PhilHealth to expedite payment to hospitals. (n.d.). Philippine News Agency. https://www.pna.gov.ph/articles/1137832
Chanco, B. (2019, July 5). Philippines healthcare unaffordable. Philstar.com. https://www.philstar.com/business/2019/07/05/1932014/philippines-healthcare-unaffordable
Common health issues Filipinos face | InLife. (n.d.). Common Health Issues Filipinos Face | InLife. https://www.insularlife.com.ph/articles/common-health-issues-filipinos-face-00000020
Comprehensive Health Insurance Plans Philippines | Kwik.insure. (n.d.). https://kwik.insure/health-insurance
Congress of the Philippines (1994). An Act Instituting a National Health Insurance Programme for All Filipinos and Establishing the Philippines Health Insurance Corporation for the Purpose. Accessed from: http://www.philhealth.gov.ph/about_us/ra7875.pdf on 26 November 2013.
Corpuz. JC., (06 September 2023). Cardiovascular disease in the Philippines: a new public health emergency? Journal of Public Health, Volume 46, Issue 1, March 2024, Pages e203–e204,
Cuenca, J.,. (December 2018). Health Devolution in the Philippines: Lessons and Insights Philippines Hospitals. (n.d.).
Dev-Site. (2021, June 9). A guide to the most common illnesses during the summer season. Makati Medical Center. https://www.makatimed.net.ph/blogs/a-guide-to-the-most-common-illnesses-during-the-summer-season/
Dineros-De Guzman, C., (June, 2018). Embracing new healthcare technologies that empower Filipinos | Needles in a haystack. PwC.
Ernesto O. Domingo, Ramon Pedro P. Paterno, Fely Marilyn E. Lorenzo1, Cecilia S. Acuin, Fernando B. Garcia, Jr., Emerito Jose A. Faraon, Anthony Rosendo G. Faraon, Alvin Valeriano B. Marcelo, Juan Antonio A. Perez III, Ricardo P. Ramos, Ma. Esmeralda C. Silva (2023). Equity in Health and the New Normal: The Philippine Universal Health Care Law.
Fran, 22 April 2022. An Introduction to the healthcare system in the Philippines. futurelearn.com
GMA Integrated News. (2023b, November 28). Increase in pneumonia cases noted in PGH. GMA News Online. https://www.gmanetwork.com/news/topstories/nation/889844/increase-in-pneumonia-cases-noted-in-pgh/story/
Grundy, j. Healy, V., Gorgolon, l., nd Sandig, E., (2003, September 1). Overview of devolution of health services in the Philippines. PubMed. https://pubmed.ncbi.nlm.nih.gov/15877513
Health Care Access - MU School of Medicine. (n.d.).
Health Care Access - MU School of Medicine. (n.d.-c). https://medicine.missouri.edu/centers-institutes-labs/health-ethics/faq/health-care-access
Health expenses remain a big burden for Pinoys despite UHC. (n.d.). https://www.pids.gov.ph/details/news/in-the-news/health-expenses-remain-a-big-burden-for-pinoys-despite-uhc
https://media.tghn.org/medialibrary/2019/08/PerinatalInfectionsTransmitted_resource.pdf
https://psa.gov.ph/pnha-press -release
https://www.officialgazette.gov.ph/2004/02/10/republic-act-no-9241/
https://www.officialgazette.gov.ph/2004/02/10/republic-act-no-9241/
Jaime A. Santos, MD. 2021. A review of Pneumonia in the Philippines. Pediatric Infectious Disease Society of the Philippines Journal. Vol. 22 p. 2
James Sherpa and Rajenda-Prasad Yadav, July 22, 2019. Perceptions of the Private Sector for Creating Effective Public-Private Partnerships against Tuberculosis in Metro Manila, Philippines. National Library of Medicine (NIH).
Jhanna Uy, Vanessa T. Siy Van, Valerie Gilbert Ulep, Diana Beatriz Bayani and Damian Walker (2022). The Impact of COVID-19 on Hospital Admissions for Twelve High-Burden Diseases and Five Common Procedures in the Philippines: A National Health Insurance Database Study 2019-2020. The LANCET Regional Health. Vol. 18, 100310, January 2022
Jhanna Uy, Christian Edward L. Nuevo, Lyle Daryll D. Casas, and Valerie Gilbert T. Ulep. The Financial Health of Select Philippine Hospitals and the Role of the Philippine Health Insurance Corporation as the National Strategic Purchaser of Health Services. PHILIPPINE INSTITUTE FOR DEVELOPMENT STUDIES. December 2021.
John Añonuevo, Camilo Oliver Aquino, Elaine Cunanan, Patrick James Encarnacion, Elmer Jasper Llanes, Diana Dalisay Orolfo, Chito Permejo, Dante Salvador Jr., Mary Joy Taneo, Anthony Russell Villanueva, Helen Ong-Garcia & Precious Juzenda Montilla. Cost-of-illness of heart failure with preserved and reduced ejection fraction in the Philippines. Journal of Medical Economics, 28(1), 814-822
Josephine Ann P. Ramos, MDFrederick Mars B. Untalan, MD. Effectiveness of the Philippine Health Insurance Corporation Case Rate System for Thyroidectomy in a Tertiary Government Hospital. Philippine Journal of otolaryngology-head and neck Surgery Vol. 35 no. 1 January – June 2020
Joson, R., More Common Healthcare Facilities in the Philippines, (2012)
Karki L, Khadka M, Joti S, Adhikari S, Tamrakar R, Oli MP, K C P, Maharjan S, Maharjan S, Basnet R, Chauhan S, Basnet P. Community-acquired Pneumonia among Elderly Patients Admitted to the Department of Medicine in a Tertiary Care Centre: A Descriptive Cross-sectional Study. JNMA J Nepal Med Assoc. 2023 Jun 1;61(262):535-538. doi: 10.31729/jnma.8202. PMID: 37464841; PMCID: PMC10276930.
Kien, V. D., Van Minh, H., Giang, K. B., Weinehall, L., & Ng, N. (2014). Horizontal inequity in public health care service utilization for non-communicable diseases in urban Vietnam. Global Health Action, 7(1). https://doi.org/10.3402/gha.v7.24919
Kwik.insure (n.d.). https://kwik.insure/kwik-hub/health-insurance/philhealth-101-everything-you-need-to-know
Lam, P. (2024, January 26). What to know about anemia. https://www.medicalnewstoday.com/articles/158800#types
Lasco, G., Yu, V., David, C., (June 29, 2022). The Lived Realities of Health Financing: A Qualitative Exploration of Catastrophic Health Expenditure Health Expenditure in the Philippines. Acta Medica Philippina. The National Health Science Journal.
Limited, S. (2022, April 13). Private vs. Public: Which Hospital is Best For You to Work in? Jobstreet. https://www.jobstreet.com.ph/career-advice/article/private-vs-public-which-hospital-is-best-for-you-to-work-in
Liwanag, H. J., & Wyss, K. (2020). Who should decide for local health services? A mixed methods study of preferences for decision-making in the decentralized Philippine health system. BMC Health Services Research, 20(1).
Liza Margarita B. Ilagan, MD; Ramoncito C. Magnaye, MD, MHA, FPCS, FPSGS; Clarence Pio Rey C. Yacapin, MD, FPCS, FPSGS; Aldrin B. Cuasay, MD, FPCS, FPSGS and Amabelle A. Moreno, MD, FPCS, FPSPS. Comparison of PhilHealth Case Rate and Actual Charge of Hospitalization for Common
In-Patient Surgical Procedures from 2017-2019 in a Level 3 Hospital. PHILIPPINE JOURNAL OF SURGICAL SPECIALTIES. Vol. 79, No. 1, January-June, 2024
Mabaquiao, Jr. N., (March 2021). Justice in Healthcare: Welfare and Equal Opportunity. Asia-Pacific Social Science Review | Vol. 21 No. 1
Mandate and Functions: About Us | PhilHealth. (n.d.). https://www.philhealth.gov.ph/about_us/mandate.php
Manila, U. E. (2023, June 29). Hospitals and medical facilities in the Philippines - U.S. Embassy in the Philippines. U.S. Embassy in The Philippines. https://ph.usembassy.gov/hospitals-and-medical-facilities-in-the-philippines/
McLaughlin CG, Wyszewianski L. Access to care: remembering old lessons. Health Serv Res. 2002 Dec;37(6):1441-3. doi: 10.1111/1475-6773.12171. PMID: 12546280; PMCID: PMC1464050
Members PhilHealth. (n.d.) https://philhealth.gov.ph/members/
Mendoza, J. E. (2023, September 29). PhilHealth shoulders almost 66% of hospital bills on average. INQUIRER.net. https://newsinfo.inquirer.net
Moore, Corey B. (2019). Policy Insight: The Philippines’ Universal Healthcare Policy (Kalusugan Pangkalahatan) and the Poor. Philippine Journal of Public Policy: Interdisciplinary Development Perspectives
Nel Jason L. Haw, Jhanna Uy, and Beverly Lorraine Ho. Association of SHI coverage and level of healthcare utilization and costs in the Philippines: a 10-year pooled analysis. Journal of Public Health, Volume 42, issue 4, December 2020.
Nisperos, G.., MD; Ornos, ED, MD (2022). View of the Philippine Universal Health Care Law: A Differing View.
Obermann, K., Jowett, M., & Kwon, S. (2018). The role of national health insurance for achieving UHC in the Philippines: a mixed methods analysis. Global Health Action/Global Health Action. Supplement, 11(1), 1483638.
On Claims and Payments, (August 5, 2021). PhilHealth Official Statement https://www.philhealth.gov.ph/ofclstmnts/2021/on_claimspayments.pdf
Pacheco-Purugganan, MC, MD (n.d.) Why is Iron Deficiency Anemia Prevalent in the Philippines?. unilab.com.ph
Paterno, R., How Do We Finance Universal Health Care in the Philippines? (2024, February 20). University of the Philippines Center for Integrative and Development Studies. University of the Philippines Center for Integrative and Development Studies. https://cids.up.edu.ph/
PhilHealth (n.d.) https://www.philhealth.gov.ph/news/2023/reminds_hospitals.pdf
PhilHealth Cash benefits for specific illness, (2019, January 17). [Complete List]. Government PH. https://governmentph.com/list-philhealth-cash-benefits-specific-illness/
PhilHealth yet to pay P500-M claims of hospitals due to lack of papers —COA. (2023, July 7) GMA News Online. https://www.gmanetwork.com/news/topstories/nation/875168/philhealth-yet-to-pay-p500-m-claims-of-hospitals-due-to-lack-of-papers-coa/story
PhilHealth, Stats and Charts 2019. https://www.philhealth.gov.ph/about_us/statsncharts/snc2019_r1.pdf
Philippine News Agency (PNA). (January 1, 2024). DOH improves healthcare, brings services closer to people. https://www.pna.gov.ph/articles/1216191
Philippine Statistical Authority, PSA (2020). About Seven Percent of Filipino Family Members Got Ill/Sick or Injured in June 2020 (Results from the 2020 Annual Poverty Indicators Survey (APIS)) release date, July 14, 2021; 2021-274 psa.gov.ph.
Philippines - healthcare. (2024, January 23). International Trade Administration | Trade.gov. https://www.trade.gov/country-commercial-guides/philippines-healthcare
Philippines - healthcare. (2024, January 23). International Trade Administration | Trade.gov. https://www.trade.gov/country-commercial-guides/philippines-healthcare
Picazo, O, (n.d.). Public hospital governance in the Philippines: A case study on health sector reforms.
PIDS-Login (n.d.). https://pidswebs.pids.gov.ph
PIDS recommends new PhilHealth payment model for fairer, more responsive health financing. (n.d.). https://pids.gov.ph/details/news/press-releases/pids-recommends-new-philhealth-payment-model-for-fairer-more-responsive-health-financing
PricewaterhouseCoopers. (n.d.). How sick is Philippine healthcare? PwC. https://www.pwc.com/ph/en/as-easy-as-abc/column/how-sick-is-philippine-healtcare.html
Pulok, M. H., Van Gool, K., & Hall, J. (2020). Horizontal inequity in the utilization of healthcare services in Australia. Health Policy, 124(11), 1263–1271. https://doi.org/10.1016/j.healthpol.2020.08.012
Ricamata, Camille Pauline R. and Tandang Nancy A. (2017). Determinants of Philippine Health Insurance Corporation (Philhealth) Coverage and Benefit Utilization. Journal of Human Ecology
Rizal Raoul Reyes (2025). PhilHealth should review hospital reimbursement rates, says study. Business Mirror
Sebastián, M. S., Mosquera, P. A., Ng, N., & Gustafsson, P. E. (2017). Health care on equal terms? Assessing horizontal equity in health care use in Northern Sweden. European Journal of Public Health, 27(4), 637–643. https://doi.org/10.1093/eurpub/ckx031
Silfverberg, D. V. (2015). Analysis of the Philippine Health Insurance Corporation’s individually paying program and employed program. ideas.repec.org.
Singlife Philippines (September 2020). Medical Health Insurance: Daily Hospitalization vs. Critical Illness
Sison, J. A., ... Punzalan, A. G., ... Tan, M. D., ... Bautista, J. L., ... Lingling-Uy, N. D., ... Buan, E. T., ... (2005).A nationwide survey on morbidity and mortality among hospital-based population in the Philippines (Phyton 4*): A report of the council on hypertension - Philippine Heart Association. Philippine Journal of Cardiology, 33(4), 151-156
Sison, J., et. al., (2005). A nationwide survey on morbidity and mortality among hospital-based population in the Philippines (Phyton 4*): A report of the council on hypertension - Philippine Heart Association
Statista. (2023, October 2). Household OOP payment share to current health expenditure Philippines 2014-2022. https://www.statista.com/statistics/1173970/philippines-share-of-out-of-pocket-health-expenditure-on-the-current-health-expenditure/
Statista. (2024a, February 20). Leading diseases Philippines 2020. https://www.statista.com/statistics/1118585/philippines-leading-cause-morbidity-by-disease/
Statista. (2024b, February 20). Leading diseases Philippines 2020. https://www.statista.com/statistics/1118585/philippines-leading-cause-morbidity-by-disease/
Uy, J., Casas LD., Nuevo, CE., Bagas, J., and Ulep, VG., (2023). Assessing PhilHealth’s State of Financing and Role as the National Purchaser of Healthcare Services. Philippine Journal of Development. Volume 47 (2023) Number 1
Uy, J., Nuevo, C.E., Casas, L.D., Ulep, V.G., (2021). The Financial Health of Select Philippine Hospitals and the Role of the Philippine Health Insurance Corporation as the National Strategic Purchases of Health Services. Philippine Institute for Development Studies.
Valerie Gilbert T. Ulep, Jhanna Uy, and Lyle Daryll Casas (2020). Primary health care for noncommunicable diseases in the Philippines. Published by Philippine Institute for Development Studies (PIDS), Quezon City. PIDS Discussion Paper Series No. 2020-39
Vision, mission, core values: about us PhilHealth (n.d.). https://www.philhealth.gov.ph/about us/vis_mis_core.ph
Vital Statistics | Philippine Statistics Authority V - BiCol. (2023, March 16). https://rsso05.psa.gov.ph/statistics/vital-stat/node/1684057015
What you should know about critical illness costs - Pru Life UK. (n.d.). Pru Life UK. https://www.prulifeuk.com.ph/en/explore-pulse/health-financial-wellness/critical-illness-comes-with-serious-costs-what-you-should-know/
World Health Organization: WHO. (2018, June 8). Health for all is key for a safer, fairer, more prosperous Philippines. https://www.who.int/
World Health Organization: WHO. (2020, July 21). Quality of care. https://www.who.int/health-topics/quality-of-care#tab=tab_1
World Health Organization: WHO. (2020, July 21). Quality of care. https://www.who.int/health-topics/quality-of-care#tab=tab_1
World Health Organization: WHO. (2023, December 1). Human rights. https://www.who.int/news-room /fact-sheets/detail/human-rights-and-health
2022; Joint-Circular/Revised-Organizational-Structure-and-Staffing-Standards-for-Level-III-General-Government-Hospitals. www.dbm.gov.ph
Admin, S., & Admin, S. (n.d.). National health insurance program (NHIP)-SDGs-philippines. SDGs-Philippines- https://sdg.neda.gov.ph/national-health-insurance-program-nhip
Allianz. (n.d.) Healthcare in the Philippines | Philippines Health Insurance .allianzcare.com.
Alvin B. Caballes, Walter Sollner, Juan Nañagas (2012). Financial protection mechanisms for inpatients at selected Philippine hospitals. ScienceDirect. Volume 75, Issue 10, November 2012, pages 1820-1827
Aparece, JP and Lam, et.al, (2023). Trends and Demographics in Heart Failure Hospitalizations in the Philippines from 2014 to 2022. Available at SSRN: https://ssrn.com/abstract=4699187 or http://dx.doi.org/10.2139/ssrn.4699187
Bernadette A. Tumanan-Mendoza MD, Victor L. Mendoza MD, Felix Eduardo R. Punzalan MD, Paul Ferdinand M. Reganit MD, and Silverose Ann A. Bacolcol MD (2015). Economic Burden of Community-Acquired Pneumonia among Adults in the Philippines: Its Equity and Policy Implications in the Case Rate Payments of the Philippine Health Insurance Corporation. ScienceDirect. Volume 6, May 2015. Pages 118-125
Blake Warren Ang and Lenora Fernandez. A prospective study on direct out-of-pocket expenses of hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease in a Philippine tertiary care center. Springer Nature Link. Volume 24, Article number 184 (2024)
Bredenkamp, C., & Buisman, L. R. (2016). Financial protection from health spending in the Philippines: policies and progress. Health Policy and Planning, 31(7), 919–927. https://doi.org/10.1093/heapol/czw011
Cabato, L. (2024, January 14). PhilHealth members’ contribution hikes to 5% this 2024. INQUIRER.net
Cacciata, M., Alvarado, I., Jose M., and Evangelista, L., (2021 Jan 31). Health determinants and risk factors for coronary artery disease among older Filipinos in rural communities. PMCID: PMC8324596
Cairncross, Carrie-Anne & Moabelo, Martin & Willie, Michael & Kabane, Sipho. (2013). Out-Of-Pocket Expenditure by Beneficiaries of Medical Schemes: 2013-2019.
Cervantes, F., (April 23, 2021). Go directs PhilHealth to expedite payment to hospitals. (n.d.). Philippine News Agency. https://www.pna.gov.ph/articles/1137832
Chanco, B. (2019, July 5). Philippines healthcare unaffordable. Philstar.com. https://www.philstar.com/business/2019/07/05/1932014/philippines-healthcare-unaffordable
Common health issues Filipinos face | InLife. (n.d.). Common Health Issues Filipinos Face | InLife. https://www.insularlife.com.ph/articles/common-health-issues-filipinos-face-00000020
Comprehensive Health Insurance Plans Philippines | Kwik.insure. (n.d.). https://kwik.insure/health-insurance
Congress of the Philippines (1994). An Act Instituting a National Health Insurance Programme for All Filipinos and Establishing the Philippines Health Insurance Corporation for the Purpose. Accessed from: http://www.philhealth.gov.ph/about_us/ra7875.pdf on 26 November 2013.
Corpuz. JC., (06 September 2023). Cardiovascular disease in the Philippines: a new public health emergency? Journal of Public Health, Volume 46, Issue 1, March 2024, Pages e203–e204,
Cuenca, J.,. (December 2018). Health Devolution in the Philippines: Lessons and Insights Philippines Hospitals. (n.d.).
Dev-Site. (2021, June 9). A guide to the most common illnesses during the summer season. Makati Medical Center. https://www.makatimed.net.ph/blogs/a-guide-to-the-most-common-illnesses-during-the-summer-season/
Dineros-De Guzman, C., (June, 2018). Embracing new healthcare technologies that empower Filipinos | Needles in a haystack. PwC.
Ernesto O. Domingo, Ramon Pedro P. Paterno, Fely Marilyn E. Lorenzo1, Cecilia S. Acuin, Fernando B. Garcia, Jr., Emerito Jose A. Faraon, Anthony Rosendo G. Faraon, Alvin Valeriano B. Marcelo, Juan Antonio A. Perez III, Ricardo P. Ramos, Ma. Esmeralda C. Silva (2023). Equity in Health and the New Normal: The Philippine Universal Health Care Law.
Fran, 22 April 2022. An Introduction to the healthcare system in the Philippines. futurelearn.com
GMA Integrated News. (2023b, November 28). Increase in pneumonia cases noted in PGH. GMA News Online. https://www.gmanetwork.com/news/topstories/nation/889844/increase-in-pneumonia-cases-noted-in-pgh/story/
Grundy, j. Healy, V., Gorgolon, l., nd Sandig, E., (2003, September 1). Overview of devolution of health services in the Philippines. PubMed. https://pubmed.ncbi.nlm.nih.gov/15877513
Health Care Access - MU School of Medicine. (n.d.).
Health Care Access - MU School of Medicine. (n.d.-c). https://medicine.missouri.edu/centers-institutes-labs/health-ethics/faq/health-care-access
Health expenses remain a big burden for Pinoys despite UHC. (n.d.). https://www.pids.gov.ph/details/news/in-the-news/health-expenses-remain-a-big-burden-for-pinoys-despite-uhc
https://media.tghn.org/medialibrary/2019/08/PerinatalInfectionsTransmitted_resource.pdf
https://psa.gov.ph/pnha-press -release
https://www.officialgazette.gov.ph/2004/02/10/republic-act-no-9241/
https://www.officialgazette.gov.ph/2004/02/10/republic-act-no-9241/
Jaime A. Santos, MD. 2021. A review of Pneumonia in the Philippines. Pediatric Infectious Disease Society of the Philippines Journal. Vol. 22 p. 2
James Sherpa and Rajenda-Prasad Yadav, July 22, 2019. Perceptions of the Private Sector for Creating Effective Public-Private Partnerships against Tuberculosis in Metro Manila, Philippines. National Library of Medicine (NIH).
Jhanna Uy, Vanessa T. Siy Van, Valerie Gilbert Ulep, Diana Beatriz Bayani and Damian Walker (2022). The Impact of COVID-19 on Hospital Admissions for Twelve High-Burden Diseases and Five Common Procedures in the Philippines: A National Health Insurance Database Study 2019-2020. The LANCET Regional Health. Vol. 18, 100310, January 2022
Jhanna Uy, Christian Edward L. Nuevo, Lyle Daryll D. Casas, and Valerie Gilbert T. Ulep. The Financial Health of Select Philippine Hospitals and the Role of the Philippine Health Insurance Corporation as the National Strategic Purchaser of Health Services. PHILIPPINE INSTITUTE FOR DEVELOPMENT STUDIES. December 2021.
John Añonuevo, Camilo Oliver Aquino, Elaine Cunanan, Patrick James Encarnacion, Elmer Jasper Llanes, Diana Dalisay Orolfo, Chito Permejo, Dante Salvador Jr., Mary Joy Taneo, Anthony Russell Villanueva, Helen Ong-Garcia & Precious Juzenda Montilla. Cost-of-illness of heart failure with preserved and reduced ejection fraction in the Philippines. Journal of Medical Economics, 28(1), 814-822
Josephine Ann P. Ramos, MDFrederick Mars B. Untalan, MD. Effectiveness of the Philippine Health Insurance Corporation Case Rate System for Thyroidectomy in a Tertiary Government Hospital. Philippine Journal of otolaryngology-head and neck Surgery Vol. 35 no. 1 January – June 2020
Joson, R., More Common Healthcare Facilities in the Philippines, (2012)
Karki L, Khadka M, Joti S, Adhikari S, Tamrakar R, Oli MP, K C P, Maharjan S, Maharjan S, Basnet R, Chauhan S, Basnet P. Community-acquired Pneumonia among Elderly Patients Admitted to the Department of Medicine in a Tertiary Care Centre: A Descriptive Cross-sectional Study. JNMA J Nepal Med Assoc. 2023 Jun 1;61(262):535-538. doi: 10.31729/jnma.8202. PMID: 37464841; PMCID: PMC10276930.
Kien, V. D., Van Minh, H., Giang, K. B., Weinehall, L., & Ng, N. (2014). Horizontal inequity in public health care service utilization for non-communicable diseases in urban Vietnam. Global Health Action, 7(1). https://doi.org/10.3402/gha.v7.24919
Kwik.insure (n.d.). https://kwik.insure/kwik-hub/health-insurance/philhealth-101-everything-you-need-to-know
Lam, P. (2024, January 26). What to know about anemia. https://www.medicalnewstoday.com/articles/158800#types
Lasco, G., Yu, V., David, C., (June 29, 2022). The Lived Realities of Health Financing: A Qualitative Exploration of Catastrophic Health Expenditure Health Expenditure in the Philippines. Acta Medica Philippina. The National Health Science Journal.
Limited, S. (2022, April 13). Private vs. Public: Which Hospital is Best For You to Work in? Jobstreet. https://www.jobstreet.com.ph/career-advice/article/private-vs-public-which-hospital-is-best-for-you-to-work-in
Liwanag, H. J., & Wyss, K. (2020). Who should decide for local health services? A mixed methods study of preferences for decision-making in the decentralized Philippine health system. BMC Health Services Research, 20(1).
Liza Margarita B. Ilagan, MD; Ramoncito C. Magnaye, MD, MHA, FPCS, FPSGS; Clarence Pio Rey C. Yacapin, MD, FPCS, FPSGS; Aldrin B. Cuasay, MD, FPCS, FPSGS and Amabelle A. Moreno, MD, FPCS, FPSPS. Comparison of PhilHealth Case Rate and Actual Charge of Hospitalization for Common
In-Patient Surgical Procedures from 2017-2019 in a Level 3 Hospital. PHILIPPINE JOURNAL OF SURGICAL SPECIALTIES. Vol. 79, No. 1, January-June, 2024
Mabaquiao, Jr. N., (March 2021). Justice in Healthcare: Welfare and Equal Opportunity. Asia-Pacific Social Science Review | Vol. 21 No. 1
Mandate and Functions: About Us | PhilHealth. (n.d.). https://www.philhealth.gov.ph/about_us/mandate.php
Manila, U. E. (2023, June 29). Hospitals and medical facilities in the Philippines - U.S. Embassy in the Philippines. U.S. Embassy in The Philippines. https://ph.usembassy.gov/hospitals-and-medical-facilities-in-the-philippines/
McLaughlin CG, Wyszewianski L. Access to care: remembering old lessons. Health Serv Res. 2002 Dec;37(6):1441-3. doi: 10.1111/1475-6773.12171. PMID: 12546280; PMCID: PMC1464050
Members PhilHealth. (n.d.) https://philhealth.gov.ph/members/
Mendoza, J. E. (2023, September 29). PhilHealth shoulders almost 66% of hospital bills on average. INQUIRER.net. https://newsinfo.inquirer.net
Moore, Corey B. (2019). Policy Insight: The Philippines’ Universal Healthcare Policy (Kalusugan Pangkalahatan) and the Poor. Philippine Journal of Public Policy: Interdisciplinary Development Perspectives
Nel Jason L. Haw, Jhanna Uy, and Beverly Lorraine Ho. Association of SHI coverage and level of healthcare utilization and costs in the Philippines: a 10-year pooled analysis. Journal of Public Health, Volume 42, issue 4, December 2020.
Nisperos, G.., MD; Ornos, ED, MD (2022). View of the Philippine Universal Health Care Law: A Differing View.
Obermann, K., Jowett, M., & Kwon, S. (2018). The role of national health insurance for achieving UHC in the Philippines: a mixed methods analysis. Global Health Action/Global Health Action. Supplement, 11(1), 1483638.
On Claims and Payments, (August 5, 2021). PhilHealth Official Statement https://www.philhealth.gov.ph/ofclstmnts/2021/on_claimspayments.pdf
Pacheco-Purugganan, MC, MD (n.d.) Why is Iron Deficiency Anemia Prevalent in the Philippines?. unilab.com.ph
Paterno, R., How Do We Finance Universal Health Care in the Philippines? (2024, February 20). University of the Philippines Center for Integrative and Development Studies. University of the Philippines Center for Integrative and Development Studies. https://cids.up.edu.ph/
PhilHealth (n.d.) https://www.philhealth.gov.ph/news/2023/reminds_hospitals.pdf
PhilHealth Cash benefits for specific illness, (2019, January 17). [Complete List]. Government PH. https://governmentph.com/list-philhealth-cash-benefits-specific-illness/
PhilHealth yet to pay P500-M claims of hospitals due to lack of papers —COA. (2023, July 7) GMA News Online. https://www.gmanetwork.com/news/topstories/nation/875168/philhealth-yet-to-pay-p500-m-claims-of-hospitals-due-to-lack-of-papers-coa/story
PhilHealth, Stats and Charts 2019. https://www.philhealth.gov.ph/about_us/statsncharts/snc2019_r1.pdf
Philippine News Agency (PNA). (January 1, 2024). DOH improves healthcare, brings services closer to people. https://www.pna.gov.ph/articles/1216191
Philippine Statistical Authority, PSA (2020). About Seven Percent of Filipino Family Members Got Ill/Sick or Injured in June 2020 (Results from the 2020 Annual Poverty Indicators Survey (APIS)) release date, July 14, 2021; 2021-274 psa.gov.ph.
Philippines - healthcare. (2024, January 23). International Trade Administration | Trade.gov. https://www.trade.gov/country-commercial-guides/philippines-healthcare
Philippines - healthcare. (2024, January 23). International Trade Administration | Trade.gov. https://www.trade.gov/country-commercial-guides/philippines-healthcare
Picazo, O, (n.d.). Public hospital governance in the Philippines: A case study on health sector reforms.
PIDS-Login (n.d.). https://pidswebs.pids.gov.ph
PIDS recommends new PhilHealth payment model for fairer, more responsive health financing. (n.d.). https://pids.gov.ph/details/news/press-releases/pids-recommends-new-philhealth-payment-model-for-fairer-more-responsive-health-financing
PricewaterhouseCoopers. (n.d.). How sick is Philippine healthcare? PwC. https://www.pwc.com/ph/en/as-easy-as-abc/column/how-sick-is-philippine-healtcare.html
Pulok, M. H., Van Gool, K., & Hall, J. (2020). Horizontal inequity in the utilization of healthcare services in Australia. Health Policy, 124(11), 1263–1271. https://doi.org/10.1016/j.healthpol.2020.08.012
Ricamata, Camille Pauline R. and Tandang Nancy A. (2017). Determinants of Philippine Health Insurance Corporation (Philhealth) Coverage and Benefit Utilization. Journal of Human Ecology
Rizal Raoul Reyes (2025). PhilHealth should review hospital reimbursement rates, says study. Business Mirror
Sebastián, M. S., Mosquera, P. A., Ng, N., & Gustafsson, P. E. (2017). Health care on equal terms? Assessing horizontal equity in health care use in Northern Sweden. European Journal of Public Health, 27(4), 637–643. https://doi.org/10.1093/eurpub/ckx031
Silfverberg, D. V. (2015). Analysis of the Philippine Health Insurance Corporation’s individually paying program and employed program. ideas.repec.org.
Singlife Philippines (September 2020). Medical Health Insurance: Daily Hospitalization vs. Critical Illness
Sison, J. A., ... Punzalan, A. G., ... Tan, M. D., ... Bautista, J. L., ... Lingling-Uy, N. D., ... Buan, E. T., ... (2005).A nationwide survey on morbidity and mortality among hospital-based population in the Philippines (Phyton 4*): A report of the council on hypertension - Philippine Heart Association. Philippine Journal of Cardiology, 33(4), 151-156
Sison, J., et. al., (2005). A nationwide survey on morbidity and mortality among hospital-based population in the Philippines (Phyton 4*): A report of the council on hypertension - Philippine Heart Association
Statista. (2023, October 2). Household OOP payment share to current health expenditure Philippines 2014-2022. https://www.statista.com/statistics/1173970/philippines-share-of-out-of-pocket-health-expenditure-on-the-current-health-expenditure/
Statista. (2024a, February 20). Leading diseases Philippines 2020. https://www.statista.com/statistics/1118585/philippines-leading-cause-morbidity-by-disease/
Statista. (2024b, February 20). Leading diseases Philippines 2020. https://www.statista.com/statistics/1118585/philippines-leading-cause-morbidity-by-disease/
Uy, J., Casas LD., Nuevo, CE., Bagas, J., and Ulep, VG., (2023). Assessing PhilHealth’s State of Financing and Role as the National Purchaser of Healthcare Services. Philippine Journal of Development. Volume 47 (2023) Number 1
Uy, J., Nuevo, C.E., Casas, L.D., Ulep, V.G., (2021). The Financial Health of Select Philippine Hospitals and the Role of the Philippine Health Insurance Corporation as the National Strategic Purchases of Health Services. Philippine Institute for Development Studies.
Valerie Gilbert T. Ulep, Jhanna Uy, and Lyle Daryll Casas (2020). Primary health care for noncommunicable diseases in the Philippines. Published by Philippine Institute for Development Studies (PIDS), Quezon City. PIDS Discussion Paper Series No. 2020-39
Vision, mission, core values: about us PhilHealth (n.d.). https://www.philhealth.gov.ph/about us/vis_mis_core.ph
Vital Statistics | Philippine Statistics Authority V - BiCol. (2023, March 16). https://rsso05.psa.gov.ph/statistics/vital-stat/node/1684057015
What you should know about critical illness costs - Pru Life UK. (n.d.). Pru Life UK. https://www.prulifeuk.com.ph/en/explore-pulse/health-financial-wellness/critical-illness-comes-with-serious-costs-what-you-should-know/
World Health Organization: WHO. (2018, June 8). Health for all is key for a safer, fairer, more prosperous Philippines. https://www.who.int/
World Health Organization: WHO. (2020, July 21). Quality of care. https://www.who.int/health-topics/quality-of-care#tab=tab_1
World Health Organization: WHO. (2020, July 21). Quality of care. https://www.who.int/health-topics/quality-of-care#tab=tab_1
World Health Organization: WHO. (2023, December 1). Human rights. https://www.who.int/news-room /fact-sheets/detail/human-rights-and-health
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