BACKGROUND

PhilHealth serves as the Philippines’ national health insurance provider and is central to implementing the Universal Health Care (UHC) Law. Despite this, existing gaps and ongoing challenges in claims and financial management systems continue to affect public healthcare facilities’ operations and sustainability.

AIMS AND OBJECTIVES

This article examined the effectiveness and challenges of PhilHealth’s claims and financial management systems in public healthcare facilities, focusing on accreditation, claims processing, reimbursements, and financial governance.

MATERIALS AND METHODS

A qualitative multiple-case study design was employed in Quezon City and the provinces of La Union, Sorsogon, Leyte, and Bukidnon, with data collected from 2022 to 2023. Prior to data collection, a certificate of exemption was granted by the Department of Health – Single Joint Research Ethics Board (DOH-SJREB). Data were collected through key informant interviews with healthcare facility heads, claims processors, and PhilHealth personnel, supplemented by document reviews and facility observations. Thematic analysis was employed to examine the implementation of national health insurance policies at the facility level.

RESULTS

Accreditation standards are uniformly defined, yet compliance varies widely, directly influencing reimbursement outcomes. Facilities with compliance gaps often face provisional accreditation, downgrades, or suspension, resulting in reduced revenue. Although the Universal Health Care (UHC) Law guarantees patient access to PhilHealth benefits, the efficiency of claims processing remains uneven and highly dependent on administrative capacity, staffing adequacy, and digital infrastructure. Systemic inefficiencies at both PhilHealth and facility levels contribute to delays and claim denials. Reimbursements are further constrained by outdated case rate ceilings, inconsistent financial practices, inadequate recordkeeping, weak information systems, and poor storage conditions—particularly in lower-level hospitals and rural health units.

CONCLUSION

Reforms in claims processing workflows, information system integration, and financial management capacities are crucial to enhance reimbursement efficiency. Strengthening these systems is fundamental for supporting sustainable, equitable, and high-quality healthcare delivery in the public sector within the Universal Health Care (UHC) framework.

Human ; Insurance, Health ; Hospitals, Public ; Delivery Of Health Care ; Universal Health Care ; National Health Programs

Objective: To compare the antimicrobial effects of locally available multipurpose contact lens solutions (MPS) on the growth of standard strains of contact lens-related ocular pathogens and to establish the recommended duration of exposure to these solutions to achieve maximal antimicrobial efficacy. Methods: This study, a single-blind controlled experiment, evaluated five locally available MPS in terms of their antimicrobial efficacy towards common contact lens-related ocular pathogens, such as P. aeroginosa, S. aureus, E. coli, F. solani, and C. albicans, using the stand alone criteria. Microbial viability counts were obtained at serial durations: after 1 hour, 3 hours, 6 hours, and 12 hours of exposure. Results: MPS containing polyquaternium-1 and myristamidopropyl dimethylamine (MAPD) and polyhexamide reduced the bacterial concentrations by 3 log and fungal concentrations by 1 log, enabling them to fulfill the stand alone criteria for disinfecting solutions as mandated by ISO/CD 14729. This antimicrobial efficacy was most evident at 6 hours of exposure to the challenge organisms. MPS containing polyquaternium-1 and MAPD also have the broadest spectrum of effectivity against gram-negative and gram-positive bacteria, and C. albicans. All MPS tested have poor microbial activity against F. solani. Conclusion Multipurpose contact lens solutions demonstrated variability in their antimicrobial activity. MPS with broad spectrum efficacy and effectivity, such as those containing polyquaternum and MAPD, are preferred to prevent contact lens-related ocular infections.
Contact Lenses