This study is a critical analysis of health services purchasing undertaken
by PhilHealth, which implements the National Health Insurance Program
of the Philippines. The study employs a principal-agent framework for
analysing three critical relationships: that between the purchaser and
healthcare providers, between the purchaser and citizens (members of
PhilHealth), and between the purchaser and the Government, both as
regulator and as funder of services, at the national Government and local
government levels.
In analysing these three relationships, the study compares three states: the
ideal or theoretical arrangement of purchasing as determined by economic
theory; the “design” as written in laws, implementing rules and regulations,
executive and administrative orders, circulars and other policies; and the
actual arrangement or practice as culled from reports and interviews with
stakeholders. Thus, the study is an analysis of the key alignments and
variances of purchasing practices vis-à-vis the “design” and the theoretical
ideal in each of the three relationships. To do this, the study employs an
extensive document review, as well as key-informant interviews with
decision-makers and other stakeholders, including PhilHealth management
and staff, the Department of Health, provider representatives and consumer
representatives.