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PhilHealth's New Engagement Process for Accrediting Hospitals January 2, 2012

The Philippine Health Insurance Corporation (PhilHealth) is improving the way it engages with health care providers such as hospitals.

PhilHealth President and CEO Dr. Eduardo P. Banzon reported that upon completion of all necessary consultations, staff work and publication of the necessary policy circular from PhilHealth early this month, all hospitals licensed by the Department of Health (DOH) shall be deemed accredited by PhilHealth as Centers of Safety and shall no longer be subjected to pre-accreditation surveys.

Consequently, these hospitals will need to sign a "Performance Commitment Contract" with PhilHealth in order to become part of the National Health Insurance Program (NHIP) and receive reimbursements. This performance commitment contract allows PhilHealth to improve the quality of services by stipulating the terms and conditions of the engagement, adopting international standards for accreditation and giving incentives to providers demonstrating good performance. Hospitals aiming for higher accreditation awards, i.e., Center of Quality and Center of Excellence , shall still undergo pre-accreditation surveys and sign the performance commitment contract with PhilHealth.

"We need to change the way we engage and do business with providers in order to achieve positive reforms in line with achieving Universal Health Care. One way is to separate accreditation with contracting of provider services. In the Philippines , these two processes are currently merged. This engagement limits the number of providers that are accredited and consequently limits access to quality health services by our members. Elsewhere in the world, these two are separate and distinct from each other," the PhilHealth Chief stressed.

"By separating the two, we can eventually attach incentives such as higher reimbursement rates for providers meeting performance targets and accredit as many facilities to give more options to our members," Banzon stated.

Accreditation is defined in the Benchbook as the process of verification of the qualification and capabilities of health care providers prior to granting of privilege of participation in the NHIP to ensure that the health care services they are to render have the desired and expected quality. (END)

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