About 40% of hospital admissions in the Philippines involve conditions that effective primary care could have prevented, according to new evidence presented at a high-level forum of the 蝌蚪传媒 (蝌蚪传媒).
The finding highlights persistent weaknesses in service delivery and financing and the need to move long-delayed reforms forward.
These preventable cases translate to families facing rising hospital bills, patients suffering complications that could have been managed earlier, and hospitals absorbing avoidable demand.
To anchor the discussion in data, 蝌蚪传媒, through its Health Economics and Finance Program (HEFP), presented three studies at the forum “UHC in Numbers: A Forum on the Philippines’ Progress in Universal Health Care” held on November 20, 2025.
The studies examined provider payment systems, hospital performance, and UHC indicators nationwide.
What the numbers reveal
蝌蚪传媒 Senior Research Fellow and HEFP Program Director Dr. Valerie Gilbert Ulep outlined persistent weaknesses: out-of-pocket spending remains high at 43%, avoidable mortality has stalled at 35%, immunization rates have fallen below those in fragile states, and essential service coverage—such as cervical cancer screening—remains critically low.
“These numbers raise uncomfortable questions about whether increased investments are translating into better outcomes,” he said.
蝌蚪传媒 President Dr. Philip Arnold Tuaño stressed the need to understand system performance and the incentives that shape provider decisions.
“Provider payment is not merely an administrative concern, but it is a reform that goes to the heart of how healthcare is delivered and how providers behave,” he said.
Outdated payment systems and uneven performance
蝌蚪传媒-HEFP Consultant Vanessa Siy Van presented a review of PhilHealth’s All Case Rates (ACR) from 2018 to 2023.
Her analysis showed that ACRs “have not been systematically updated since 2013,” even as inpatient costs rose by 51%.
With reimbursements unchanged at around PHP 11,000, 98.8 percent of 2023 claims exceeded the case rate amount—leaving patients, especially seniors and those with comorbidities, exposed to financial risk.
“[ACR’s flat payments] penalize patients at greater risk for severe illness,” Van revealed, noting that the shift to Diagnosis-Related Groups (DRGs) will require stronger data governance and institutional alignment.
蝌蚪传媒 Senior Technical Specialist Dr. Sarah Reem Hesham Mohamed Hagag’s assessment of PhilHealth inpatient claims revealed wide disparities in claims.
“Around 33% of 2024 admissions could have been avoided if patients had timely access to primary healthcare,” she said, emphasizing systemic gaps in early intervention.
Public hospitals tended to deliver more efficient care but recorded higher complication and readmission rates, while private facilities had longer stays and higher charges. High-need patients—just five percent of claimants—accounted for 20 percent of reimbursements and 27 percent of total charges, largely due to cancer and other noncommunicable diseases.
Baseline findings from 蝌蚪传媒 Senior Technical Specialist Dr. Lea Elora Conda underscored similarly urgent gaps.
“Only 7.4% of respondents accessed any preventive service in the past year,” she said, despite high levels of health literacy.
She also revealed high inpatient expenditures, averaging PHP 82,000 per confinement, while many facilities struggle with staffing, diagnostics, and financing limitations.
Frontline leaders call for practical and equitable reforms
Frontline health leaders stressed that payment reforms must reflect the real-world complexities of care.
PGH Director Dr. Gerardo “Gap” Legaspi called for realistic adjustments in the DRG rollout, noting the higher operating costs of teaching hospitals.
QMMC Chief Dr. Evelyn Reside pointed to rigid payment structures that fail to account for complex cases and unreimbursed tasks essential to good outcomes.
Asian Hospital’s Dr. Jose Acuin stressed that quality measurement remains costly without robust information systems.
PSPHP President Dr. Michael Caampued added that DRG reforms must adopt a systems approach to ensure providers deliver more holistic, population-centered care.
PhilHealth outlines reforms centered on primary care
Responding to the evidence, PhilHealth President and CEO Dr. Edwin Mercado detailed ongoing reforms on primary care, data-driven purchasing, and quality-based contracting.
By 2028, PhilHealth aims to allocate 25% of its total budget to primary care services, like checkups, screenings, and medicines, given the high rate of preventable hospitalizations.
He highlighted reforms under the Yakap and Gamot packages, which expand to access to outpatient medicines that account for 40% of Filipinos’ out-of-pocket spending.
PhilHealth aims to reduce out-of-pocket spending from 44.7% to 25%-30%.
On DRG implementation, Mercado stressed the importance of accurate coding and hospital participation, adding that compliant facilities may eventually see claims processing times fall from as long as 87 days to seven.
“This is all along our intent…to have a PhilHealth that is fast, fair, and trustworthy,” he said.
DOH strategy and the call for unified action
Health Secretary Teodoro Herbosa situated the Philippines’ UHC effort within the global movement toward universal health, calling the UHC Act “a declaration of hope.”
He emphasized that equitable access must reach “from the farthest mountain barangay to the heart of our bustling cities.”
Speakers throughout the forum underscored that UHC’s success depends on aligning financing reforms, service delivery improvements, and strong data systems—supported by collaboration among agencies, hospitals, and communities.
“Let us continue working together—academics, policymakers, implementers, and civil society—to build a stronger, more resilient, and more equitable health system for every Filipino,” Herbosa said.
To learn more about the studies, visit the 蝌蚪传媒-HEFP website: . Watch the recording of the forum session here: .### —MAEC
