To develop an efficient and seamless system towards providing truly universal health care for the Filipinos, the Philippine Institute for Development Studies-Health Economics and Finance Program (PIDS-HEFP) was recently joined by the Department of Health (DOH), PhilHealth, and the Commission on Audit (COA) in a bilateral dialogue and workshop with Thailand’s National Health Security Office (NHSO) in Bangkok.
According to the government think tank, the Philippine government aims to beef up its hospital information systems, global budgets, and an improved inpatient classification system.
The PIDS said it wants to observe and learn from the Thai experience with global budgets, electronic transfers, and layered audits. These helped provide a solid technical foundation for provider-payment systems that the Philippines could adapt and improve on to reduce Filipino impatiens’ out-of-pocket costs.
Co-organized with the World Bank, the activity is a practical step toward the design and implementation of an evidence-based Diagnosis Related Group (DRG) inpatient classification system mandated by the Philippine Healthcare Act.
Interaction with Thai experts
The Philippine delegation engaged Thai experts on diagnosis-related group (DRG) governance, budgeting, auditing, and hospital operations, key areas of concern in the Philippines’ transition to a DRG-based payment mechanism.
Moreover, the Filipinos were able to look at how Thailand pairs DRGs with a regionally allocated global budget; uses the Smart Money Transfer system to manage electronic healthcare claims data; and enforces strict claim timeliness and audit rules to protect budgets and improve data quality. These mechanisms were discussed with the aim of adapting these to the Philippine context.
The PIDS-HEFP team also presented updates on data collection for DRG reform and outlined its technical assistance on data analytics, complementing PhilHealth’s updates on policy and IT system development.
The program also included a visit to the Thai Case-Mix Center, a neutral agency that develops and regularly updates the Thai DRG grouper and relative weights through routine research studies and costing activities, and field exposure at Bang Pa-In Hospital, showcasing how the DRG system is applied along the patient’s journey. The team also examined no-balance-billing enforcement, no-fault patient compensation, and penalties for late claims-controls that balance provider sustainability with patient protection.
Building the foundation
The observation tour will enhance the 2023 PhilHealth-PIDS study tour and underscores an integrated approach to DRG adoption. By grounding design choices in Thailand’s mature systems, from budgeting and payments to AI-assisted claim review and audit, the delegation has gathered technical guidance to support the Philippines’ transition planning to the DRG system, engaging stakeholders from hospitals and professional societies.
PIDS-HEFP’s analytics work ties directly to key decisions on the design and calculation of global budgets, base rates, relative weights, and DRG grouper revision cycles; PhilHealth’s policy and IT tracks inform e-claims automation and fund flows; the DOH’s vantage point ensures alignment with hospital information systems and national practice guidelines for service delivery; and the COA ensures that the government’s auditing rules and regulations accommodate payment reforms.
A total of 14 delegates joined the study program: PIDS-HEFP’s Senior Research Specialist Lyle Daryll Casas, Senior Technical Specialist Sarah Reem Hesham Mohamed Hagag, Research Specialist Therese Jules Tomas, and Technical Specialist Louie Iyar Dagoy; as well as five delegates from PhilHealth, three from the DOH, and one each from the COA and the World Bank.