The Philippines is exploring a data-driven overhaul of its hospital payment systems to improve universal healthcare, following a study tour of Thailand’s system.
Philippine health experts and officials from the Department of Health (DOH), PhilHealth, the Commission on Audit (COA) and the Philippine Institute for Development Studies (PIDS) attended a workshop and bilateral dialogue with Thailand’s National Health Security Office (NHSO) in Bangkok from Aug. 26 to 28, 2025.
The visit focused on Thailand’s use of Diagnosis Related Groups (DRG), a system that classifies hospital cases for payment, paired with global budgets and electronic claims transfers. The goal is to adapt these models to reduce Filipino patients’ out-of-pocket costs.
The Philippine delegation learned how Thailand’s system uses a regionally-allocated global budget, a “Smart Money Transfer” system for electronic claims, and strict audit rules to manage budgets and improve data quality.
Co-organized with the World Bank, the activity is a key step toward designing and implementing an evidence-based DRG system, as mandated by the Philippine Healthcare Act.
The Philippine delegation visited the Thai Case-Mix Center, a neutral agency that develops and updates the DRG system, and Bang Pa-In Hospital to see how the system is applied. They also examined controls that balance provider sustainability with patient protection, such as no-balance-billing enforcement and penalties for late claims.
The PIDS-HEFP team presented updates on data collection for DRG reform and technical assistance on data analytics, while PhilHealth shared updates on policy and IT system development.
The delegates, which included experts from PIDS-HEFP, PhilHealth, the DOH, COA, and the World Bank, gathered technical guidance to support the country’s transition to the DRG system.
The PIDS’s analytics will inform decisions on global budgets and base rates, while PhilHealth’s IT track will guide e-claims automation. The DOH will ensure alignment with hospital information systems, and the COA will adapt auditing rules for the payment reforms.
