PhilHealth

1st PhilHealth - National Health Security Office (NHSO) Bilateral Health Financing Dialogue and Workshop for World Bank08-26-2025

Philippines, Thailand Collaborate on Universal Healthcare Innovations

The Philippine Health Insurance Corporation (PhilHealth), in partnership with the Philippine Institute of Development Studies (PIDS), along with the support of the World Bank, and the National Health Security Office of the Kingdom of Thailand conducted the 1st PhilHealth-National Health Security Office (NHSO) Bilateral Health Financing Dialogue and Workshop last August 26 to 28, 2025 in Bangkok, Thailand. This is the first event following the signing of the Memorandum of Understanding (MOU) between PhilHealth and the NHSO last November 27, 2024.

The three-day workshop focused on in-depth knowledge exchange on health financing, with PhilHealth learning from Thailand's extensive experience in implementing universal health care for its citizens, with particular focus on the use of a Diagnosis-Related Group (DRG) provider payment mechanism (PPM) and its related information technology (IT) systems. Technical representatives from the Department of Health (DOH) and Commission on Audit (COA) also took part in this workshop.

Day 1: Foundational Discussions and Thai Health System Overview

Day one covered health system overviews. PhilHealth provided updates on its DRG system, including "Shadow Billing" for data collection. NHSO presented Thailand's universal healthcare, including its three major public insurance schemes: Civil Servant Medical Benefit Scheme (CSMBS), Social Health Insurance (SHI), and Universal Coverage Scheme (UCS), with the latter covering 70% of the population, managed by NHSO, and funded by general taxation. The UCS employs a variety of PPMs, including capitation for outpatient care and a global budget (GB) with DRG for inpatient services. Furthermore, the NHSO shared their costing and budget planning and allocation processes which are influenced by good governance, multi-stakeholder participation, and evidence-based recommendations.

The afternoon session was a discussion with the Thai Case Mix Center (TCMC), responsible for Thailand's DRG. They detailed Thailand's gradual, five-year transition from a fixed-fee schedule (FFS) to a 100% DRG-based payment system and highlighted key DRG updates like RW0d (Relative Weight for zero-day stay), which adjusts payments for very short inpatient stays.

Day 2: Financial Mechanisms and Auditing Systems

The second day dove deeper into the financial and IT systems that serve as the underpinnings of Thailand's health financing. The GB was also a major topic of discussion. The NHSO explained that hospitals have a capped GB based on a forecast of their performance, and payments for all DRG cases must not exceed this cap. This GB is managed by their respective NHSO regional offices. The NHSO emphasized that having a GB PPM incentivizes hospitals to manage costs, and avoid unnecessary treatments. Therefore, hospitals that stay within their budget can keep their savings which are regarded as efficiency gains.

The discussion on the claims and audit system was particularly insightful. The NHSO highlighted the importance of a well-developed, electronic pre- and post-auditing system. They have integrated artificial intelligence (AI) into the pre-audit process to efficiently review the high volume of claims, which can reach 480,000 per day. The AI flags potential errors and fraud, complementing — not replacing — human reviewers. The NHSO also implements a hospital grading system to reinforce good performance.

Day 3: Hospital-Level Implementation and Future Collaboration

The final day of the workshop featured a practical visit to Bang Pa-in Hospital, a district-level public hospital in Thailand providing primary care. The Philippine delegation observed the hospital's streamlined healthcare systems, including self-service kiosks for patient registration and vital sign collection, and an electronic medical record (EMR) system integrated with the NHSO's claims platform. They also saw the backend operations for auditing patient records and managing claims. The workshop concluded with discussions on future collaborations, including a 2026 work plan, aiming to leverage Thailand's insights to improve the Philippines' health financing systems.

---