The reimbursement model underpinning the claims bill is acknowledged as obsolete
A 2025 study by the Philippine Institute for Development Studies (PIDS) found that PhilHealth’s all case rates (ACR) system, introduced in 2013, has not kept pace with rising hospital costs. Of 8,869 existing case rates, 99.9% had not been systematically updated since 2013. Between 2018 and 2023, average hospital charges increased 51%, from PHP23,852 to PHP36,130, while mean PhilHealth reimbursements remained around PHP11,000. By 2023, 98.8% of hospital claims had charges exceeding the applicable case rate, up from 76.7% in 2018.