Technical Assistance on the Universal Health Care (UHC) Provider Payment Reforms for 2024: Diagnosis-Related Groups (DRGs), Comprehensive Outpatient Benefit Package (COBP), and the Center for Healthcare Finance and Economics (CHFE)

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In 2022, PhilHealth formed a partnership with the Thai CaseMix Centre (TCMC) to aid with the development of the Philippine DRGs based on the Thai DRG version 5 (TDRGv5).5 The TDRGs cover a wide and complex case mix, from multiple treatment procedures for a disease to subacute care and psychiatric care. The 蝌蚪传媒 (蝌蚪传媒) aims to provide technical assistance to PhilHealth in its adoption of the TDRGv5 and to support its ongoing transition to a DRG-GB system for inpatient benefits. This project is a continuation of 蝌蚪传媒 first pilot of the DRG calculations and partnership with the PhilHealth UHC Surge Team (UHCST) that started in 2023. Specifically, this project aims to provide support in terms of quantitative analysis for DRG rate-setting, monitoring of claims form 5 data from shadow billing, policy recommendations for health financing decisions that will affect DRG-GB payment, and revision of PhilHealths costing methodology.