Please use this identifier to cite or link to this item: https://hdl.handle.net/10419/339148 
Year of Publication: 
2026
Series/Report no.: 
PIDS Discussion Paper Series No. 2025-59
Publisher: 
Philippine Institute for Development Studies (PIDS), Quezon City
Abstract: 
In this study, we assessed the readiness of PhilHealth's health information system (HIS) to support the transition to Diagnosis-Related Groups with Global Budgets (DRG-GB) as envisioned in the Universal Health Care Act of 2019. Using a framework that examines data generation, fiduciary management, and performance analysis, we identified systemic weaknesses across all three domains. The claims system produces incomplete coded data, with ungroupable claims and weak feedback mechanisms undermining case-mix measurement; fiduciary oversight is shaped by fragmented and manual fraud detection, non-integrated clinical and financial records, and limited technical capacity; and performance monitoring is constrained by siloed systems, the absence of standardized indicators, and weak hospital benchmarking. These challenges could potentially limit the ability of PhilHealth to generate reliable DRG tariffs, enforce accountability, and monitor provider behavior with this new payment system. Strengthening coding standards, integrating clinical and financial data, modernizing digital infrastructure, and institutionalizing real-time performance monitoring are critical to ensuring effective DRG-GB implementation and achieving UHC goals.
Subjects: 
Diagnosis-related groups
global budget
PhilHealth
health information system
information technology
Persistent Identifier of the first edition: 
Document Type: 
Working Paper

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