Please use this identifier to cite or link to this item: https://hdl.handle.net/10419/339139 
Year of Publication: 
2025
Series/Report no.: 
PIDS Discussion Paper Series No. 2025-61
Publisher: 
Philippine Institute for Development Studies (PIDS), Quezon City
Abstract: 
Hospital readmissions are often used to measure quality and continuity of care within health systems. In 2024, the Philippine Health Insurance Corporation (PhilHealth) removed its Single Period Confinement (SPC) Rule, a longstanding policy that denied reimbursements for readmissions within 90 days for the same primary case rate or diagnosis. Originally intended to deter unnecessary admission, the SPC Rule drew criticism for hampering access and reducing financing protection. In this study, we present the first empirical analysis of PhilHealth's readmission policy using inpatient claims from 2018 to 2023 to assess the magnitude and cost of all-cause, planned, and avoidable hospital readmissions in the Philippines. We compared readmission trends across hospital levels and ownership, and among patient groups. We found that readmission rates were significantly lower than those observed in other countries. The rates of avoidable and complication-related readmissions remained stagnant over the five years for all hospital levels, indicating a lack of significant changes in provider service delivery. Instead, the policy exposed the most vulnerable Filipinos to greater financial risk, as elderly and indigent Filipinos had the greatest share of avoidable readmissions. The removal of the SPC Rule is an opportunity to systematically redesign how readmissions in the Philippines are measured, monitored, and minimized, and shift to a provider payment system that integrates quality assessments in payment determination. PhilHealth must distinguish planned or routine readmissions from unplanned and avoidable readmissions that may be indicative of hospital-acquired complications. A robust readmission monitoring system can inform value-based purchasing decisions that ensure Filipinos receive quality and complete care without excessive financial risk. Finally, readmission policies must be supported by programs that bridge the continuum of care prior to and after patient discharge. Absent these, PhilHealth will continue to reward avoidable readmissions that come at great cost to patients' health and financial status.
Subjects: 
PhilHealth
hospital readmissions
single period of confinement
health policy
avoidable readmissions
quality of care
value-based purchasing
Persistent Identifier of the first edition: 
Document Type: 
Working Paper

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