Population-based Health Services.
SEC. 17. Population-based Health Services. - The DOH shall endeavor to contract province-wide and city-wide health systems for the delivery of population-based health services. Province-wide and city-wide health systems shall have the following minimum components:
(a) Primary care provider network with patient records accessible throughout the health system;
(b) Accurate, sensitive, and timely epidemiologic surveillance systems; and
(c) Proactive and effective health promotion programs or campaigns.
Individual-based Health Services.
SEC. 18. Individual-based Health Services. - (a) PhilHealth shall endeavor to contract public, private, or mixed health care provider networks for the delivery of individual-based health services: Provided, That member access to services shall not be compromised: Provided, further, That these networks agree to service quality, co-payment/co-insurance, and data submission standards: Provided, furthermore, That during the transition, PhilHealth and DOH shall incentivize health care providers that form networks: Provided, finally, That apex or end^referral hospitals, as determined by the DOH, may be contracted as stand-alone health care providers by PhilHealth.
(b) PhilHealth shall endeavor to shift to paying providers using performance-driven, close-end, prospective payments based on disease or diagnosis related groupings and validated costing methodologies and without differentiating facility and professional fees; develop differential payment schemes that give due consideration to service quality, efficiency and equity; and institute strong surveillance and audit mechanisms to ensure networks' compliance to contractual obligations.
