Republic Acts1 min read
Section 18Sec./Art. 18
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Individual-based Health Services. -
(a) PhilHealth shall endeavor to contract public, private, or mixed health care provider networks for the delivery of individual-based health services: Provided, That member access to services shall not be compromised: Provided, further, That these networks agree to service quality, co-payment/co-insurance, and data submission standards: Provided, furthermore, That during the transition, PhilHealth and DOH shall incentivize health care providers that form networks: Provided, finally, That apex or end-referral hospitals, as determined by the DOH, may be contracted as stand-alone health care providers by PhilHealth.
(b) PhilHealth shall endeavor to shift to paying providers using performance-driven, close-end, prospective payments based on disease or diagnosis related groupings and validated costing methodologies and without differentiating facility and professional fees; develop differential payment schemes that give due consideration to service quality, efficiency and equity; and institute strong surveillance and audit mechanisms to ensure networks compliance to contractual obligations.
CHAPTER V
ORGANIZATION OF LOCAL HEALTH SYSTEMS
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