Optimizing PhilHealth’s case-based payment scheme to achieve greater financial protection

rovider payment mechanisms are defined as “types of contracts among two or more players—patients, providers, and payers—that create specific incentives for the provision of health care and minimize the risk of opportunistic behavior” (Maceira 1998, p. 1–5). However, payment schemes vary considerably in terms of their payment and reimbursement criteria that incentivize the provision of certain types and quantities of health services. These incentives, or disincentives, affect the type, amount, and, ultimately, the quality of health services that are being provided by influencing supply and demand in the health-care sector. Therefore, the choice and implementation of certain provider payment mechanisms may have a profound influence on the health-care delivery system as a whole. It is in this realm that insurers, such as the Philippine Health Insurance Corporation (PhilHealth), may influence the health-care system for the better.