Baseline assessment of the implementation of provider payment and outpatient benefit reforms in the Philippines

The Universal Health Care (UHC) Act of 2019 introduces comprehensive reforms to address longstanding demand and supply constraints in the Philippine health system. Key reform areas include shifting provider payment mechanisms of PhilHealth to a global budget and expanding primary healthcare (PHC) and drug benefits. The Department of Health and PhilHealth will implement Health Care Provider Networks (HCPNs) as a key service delivery platform to integrate care at the province level. These reforms will be piloted in select provinces through the HCPN Demonstration Program. A robust impact evaluation is critical given the profound system-wide effects, which require baseline assessment of the population, healthcare providers, and health facilities before implementation. Data collection should include comparator sites to establish counterfactual data, allowing for a more accurate estimation of program impact. To support this effort, the Philippine Institute for Development Studies (PIDS) was tasked with designing an impact evaluation framework, developing data collection tools, and collecting baseline data of the eight (8) provinces at three (3) levels: population-level, facility-level, and provider-level. This paper summarizes key indicators of eight provinces at the baseline level prior to the implementation of the reforms. Key findings show differences across population health status, healthcare-seeking behavior, and financial risk protection. There are also persistent challenges seen in terms of affordability of services and service readiness of facilities. Quality of care emerged as a concern given the workload of healthcare providers and resource constraints. This baseline evaluation provides a critical reference point for measuring the effects of UHC reforms. This report should be paired with an end-line survey of the same sites to properly isolate the effects of the HCPN demonstration program as an intervention.