A validation framework and key performance indicators for the assessment of PhilHealth performance / Mary Clarisse Kilayco [and three others]
Subject(s): Abstract: PhilHealth, the corporation tasked with implementing the National Health Insurance Program (NH1P) of the Philippines is now entering its 12th year of operations. RA 7875 mandated PhilHealth to "provide all citizens of the Philippines with the mechanism to gain financial access to health services ... especially that segment of the population who cannot afford such services." In terms of generating Health Financing, PhilHealth's Premium Collection of P18.3 Billion in 2005 was much greater than the 2005 P9.7 Billion budget of the entire Department of Health (DOH). PhilHealth is in a position to greatly influence the way health care is delivered in the Philippines and ultimately affect the health status of Filipinos. To date however, no baseline evaluation study has been done regarding its performance with its mandated Social Health Insurance role and its function in Health Financing. This paper aims to describe a validation framework for the evaluation of PhilHealth performance as mandated by RA 9241 and to identify Key Performance Areas and Indicators for PhilHealth for the conduct of a baseline and subsequent validation studies. The key processes of PhilHealth were identified from the laws that established it (RA 7875 as amended by RA 9241) and its Implementing Rules and Regulations (IRR). These were then analyzed through the lenses of the five policy goals Equity, Quality, Effectiveness, Efficiency and Sustainability to formulate key performance areas and indicators per Health Policy goal. The preliminary results were presented to major stakeholders involved with PhilHealth in a PhilHealth Colloquium in May 2005 and were finalized based on an adaptation of the WHO framework of Carrin and James for Social Health Insurance. The Validation Framework identified the following key performance areas for the evaluation of PhilHealth performance: coverage, support value, availability of accredited facilities/providers, utilization rates, beneficiary and service provider satisfaction, administrative efficiency, sustainability, Medium Term Philippine Development Plan Social Health Insurance (SHI) targets and SHI share of the National Health Expenditures. (Author)| Cover image | Item type | Current library | Home library | Collection | Shelving location | Call number | Materials specified | Vol info | URL | Copy number | Status | Notes | Date due | Barcode | Item holds | Item hold queue priority | Course reserves | |
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DOH Central Library Electronic Resource Section | J000010 (Browse shelf(Opens below)) | Available | D0001J000010 |
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PhilHealth, the corporation tasked with implementing the National Health Insurance Program (NH1P) of the Philippines is now entering its 12th year of operations. RA 7875 mandated PhilHealth to "provide all citizens of the Philippines with the mechanism to gain financial access to health services ... especially that segment of the population who cannot afford such services." In terms of generating Health Financing, PhilHealth's Premium Collection of P18.3 Billion in 2005 was much greater than the 2005 P9.7 Billion budget of the entire Department of Health (DOH). PhilHealth is in a position to greatly influence the way health care is delivered in the Philippines and ultimately affect the health status of Filipinos. To date however, no baseline evaluation study has been done regarding its performance with its mandated Social Health Insurance role and its function in Health Financing.
This paper aims to describe a validation framework for the evaluation of PhilHealth performance as mandated by RA 9241 and to identify Key Performance Areas and Indicators for PhilHealth for the conduct of a baseline and subsequent validation studies. The key processes of PhilHealth were identified from the laws that established it (RA 7875 as amended by RA 9241) and its Implementing Rules and Regulations (IRR). These were then analyzed through the lenses of the five policy goals Equity, Quality, Effectiveness, Efficiency and Sustainability to formulate key performance areas and indicators per Health Policy goal.
The preliminary results were presented to major stakeholders involved with PhilHealth in a PhilHealth Colloquium in May 2005 and were finalized based on an adaptation of the WHO framework of Carrin and James for Social Health Insurance. The Validation Framework identified the following key performance areas for the evaluation of PhilHealth performance: coverage, support value, availability of accredited facilities/providers, utilization rates, beneficiary and service provider satisfaction, administrative efficiency, sustainability, Medium Term Philippine Development Plan Social Health Insurance (SHI) targets and SHI share of the National Health Expenditures. (Author)
In: Acta Medica Philippina, 2007 vol. 41 (1) pages: 13-23
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