What is it about?
The study explores how PhilHealth’s claims and financial management systems operate in public hospitals, focusing on accreditation, claims processing, reimbursements, and financial governance. It examines the gap between national UHC policy and actual implementation at the facility level across selected urban and provincial settings.
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Why is it important?
PhilHealth reimbursements are vital for public hospital sustainability and UHC implementation. Delays, denials, and inefficiencies in claims processing weaken hospital finances, affect service delivery, and limit patient access. Understanding these gaps helps inform reforms that improve efficiency, equity, and financial protection.
Perspectives
The study uses a multi-level perspective, integrating policy, institutional, and frontline administrative views. It highlights health system and equity perspectives by showing how capacity, digital infrastructure, and governance issues disproportionately affect lower-level and rural public health facilities.
Meljun Banogon
University of the Philippines Los Banos
Read the Original
This page is a summary of: Bridging policy and practice: A qualitative study on PhilHealth claims and financial processes in public hospitals, Philippine Journal of Health Research and Development, July 2025, Wolters Kluwer Health,
DOI: 10.4103/pjhrd.pjhrd_6_25.
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