Evaluation of the healthcare provider performance assessment system as a quality monitoring tool: a quantitative analysis

Background: The Healthcare Provider Performance Assessment System (HCPPAS) is PhilHealth’s primary framework for monitoring the quality and financial accountability of healthcare providers under the Philippine Universal Health Care (UHC) Act. Objectives: This article presents a quantitative evaluation of HCPPAS to determine the adequacy, implementability, reliability, efficiency, and effectiveness of its monitoring tools and processes. Methods: A cross-sectional descriptive design combined administrative data from PhilHealth (2018–2021) with structured surveys of personnel from four purposively selected PhilHealth Regional Offices (PROs–III, NCR, VII, and XI) and patient–caregiver respondents from four PhilHealth Customer Assistance, Relations and Empowerment Staff (PCARES) service areas. Staff surveys assessed six dimensions of HCPPAS performance using a six-point Likert scale, whereas patient and caregiver surveys measured clarity, comprehensiveness, and usability of the patient exit survey and complaint form. Descriptive statistics were computed and disaggregated by region to identify coverage trends and credibility gaps. Results: Results show that HCPPAS provides a basic structural foundation for national quality assurance but exhibits uneven regional performance and persistent operational constraints. Facility monitoring coverage failed to consistently reach the national benchmark of 80% from 2018 to 2021, reflecting vulnerability to external disruptions such as the COVID-19 pandemic. Across PhilHealth Regional Offices (PROs), respondents “slightly agreed” on the adequacy, implementability, and reliability of HCPPAS tools, but highlighted deficiencies in digital infrastructure, workforce capacity, and standardized protocols. Efficiency emerged as the weakest dimension due to chronic staff shortages and overlapping responsibilities, whereas the quality of user training and patient exit surveys received the most favorable ratings. Conclusion: These findings affirm HCPPAS as a structurally sound but operationally constrained mechanism. Strengthening digital infrastructure, institutionalizing independent verification, modernizing tools, and creating a centralized data warehouse are essential to transform HCPPAS from a compliance-driven exercise into a strategic purchasing instrument that safeguards equity, enhances financial risk protection, and drives continuous quality improvement under UHC.