Baja, Emmanuel S. Castillo-Carandang, Nina T. Viray, Brent Andrew G. Tagle, Pamela A.
Year of Publication:
PIDS Discussion Paper Series 2014-41
The PhilHealth Customer Assistance, Relations and Empowerment Staff (CARES) project was launched in 2012 to help members and their families navigate the complex Filipino health care system. The study assesses the design and quality of implementation of the PhilHealth CARES project in selected hospitals in PhilHealth's National Capital Region (NCR). The specific objectives were: (1) understand the overall goals and objectives of the project and how these are being understood by the project managers, implementers, and staff in selected areas in NCR; (2) evaluate to what extent project objectives are being met; (3) identify the project strengths, weaknesses, opportunities, and threats as perceived by CARES managers, implementers, and staff; and (4) craft appropriate policy and programmatic responses to improve project implementation.Focus group discussions and desk review (i.e., documents and records review) were the main methods for the study. Observations and mystery client visits to four PhilHealth-accredited hospitals in NCR (private and public, Level 2 and 3) were also done. The study found there were a few critical gaps (weak technical support, discrepancies among offices in policy implementation/interpretation, problematic claiming procedures, etc.) in the execution and operation of the project which needed to be addressed so as to fully maximize the benefits of the project and ensure its sustainability not just as a project but as a program in the future.
service delivery Philippines social health insurance patient navigation