Health benefit utilization and out-of-pocket expenses in outpatient care and hospitalizations: Baseline surveys of three primary care sites in the Philippines

Background@#The Philippine Primary Care Studies (PPCS) is a network of pilot studies that developed, implemented, and tested strategies to strengthen primary care in the country. These pilot studies were implemented in an urban, rural, and remote setting. The aim is to use the findings to guide the policies of the national health insurance program (PhilHealth), the main payor for individualized healthcare services in the country.@*Objective@#The objective of this report is to compare baseline outpatient benefit utilization, hospitalization, and health spending, including out-of-pocket (OOP) expenses, in three health settings (urban, rural, and remote). These findings were used to contextualize strategies to strengthen primary care in these three settings.@*Methods@#Cross-sectional surveys were carried out using an interviewer-assisted questionnaire on a random sample of families in the urban site, and a stratified random sample of households in the rural and remote sites. The questionnaire asked for out-patient and hospitalization utilization and spending, including the OOP expenses. @*Results@#A total of 787 families/households were sampled across the three sites. For outpatient benefits, utilization was low in all sites. The remote site had the lowest utilization at only 15%. Unexpectedly, the average annual OOP expenses for outpatient consults in the remote site was PhP 571.92/per capita. This is 40% higher than expenses shouldered by families in the rural area, but similar with the urban site. For hospital benefits, utilization was lowest in the remote site (55.7%) compared to 75.0% and 78.1% for the urban and rural sites, respectively. OOP expenses per year were highest in the remote site at PhP 2204.44 per capita, probably because of delay in access to healthcare and consequently more severe conditions. Surprisingly, annual expenses per year for families in the rural sites (PhP 672.03 per capita) were less than half of what families in the urban sites spent (PhP 1783.38 per capita). @*Conclusions@#Compared to families in the urban site and households in the rural sites, households in remote areas have higher disease rates and consequently, increased need for outpatient and inpatient health services. When they do get sick, access to care is more difficult. This leads to lower rates of benefit utilization and higher out-of-pocket expenses. Thus, provision of “equal” benefits can inadvertently lead to “inequitable” healthcare, pushing disadvantaged populations into a greater disadvantage. These results imply that health benefits need to be allocated according to need. Families in poorer and more remote areas may require greater subsidies.

Setting core competencies of health workers towards quality primary care: Proceedings of a National Consultative Workshop

@#The National Academy of Science and Technology (NAST), in cooperation with the Philippine Primary Care Studies (PPCS), organized the Stakeholders’ Meeting on Training Objectives for Primary Care in the Philippines on February 1, 2018, at Hotel Jen, Pasay City. The stakeholder’s meeting arrived at a consensus on the objectives of primary care workshops, training the existing cadre of doctors, nurses, midwives, and BHWs in the country. Competencies built upon these training objectives will strengthen the capacity of health care workers to render patient-centered primary care services. The expected output was not intended to replace the objectives of existing professional training curricula. Instead, the consensus obtained through this meeting works to establish the framework from which future primary care training workshops can be built upon.

Equity in health benefit utilization and financial risk protection in outpatient and inpatient care: Baseline survey of two socioeconomic groups of a pilot primary care benefits scheme in the catchment areas of a university-based health facility

Background@#Health inequities in the Philippines are driven by health workforce maldistribution and health system fragmentation. These can be addressed by strengthening primary care through central social health insurance (PhilHealth) coverage. However, high reported PhilHealth population coverage and health provider accreditation have not necessarily increased health benefit utilization or financial risk protection.@*Objective@#This study aims to examine the impact of an enhanced, comprehensive primary care benefits package at a university-based health facility. This paper reports baseline utilization of health services and health benefits, and out-of-pocket health spending in two socioeconomic strata of the catchment population, for outpatient and inpatient services.@*Methods@#A questionnaire-guided survey was done among randomly selected faculty (higher income group) and non-faculty (lower income group) employees to determine the frequencies and costs of using outpatient and inpatient health services, and amounts paid out-of-pocket.@*Results@#Annually, both groups had approximately 1 consultation/patient and about 15 hospitalizations per 100 families annually. For hospitalizations, non-faculty inpatients utilized health insurance more frequently than faculty inpatients (75.7% vs. 66.7%), but paid higher out-of-pocket proportions (73.3% or Php 92,479/hospitalization vs. 57.4% or Php 16,273/hospitalization). For outpatient care, health benefit utilization rates were higher among non-faculty (12.4% vs 2.1% of consultations) although low overall, with similar total (Php 2,319 vs Php 1,741) and out-of-pocket expenses (100%).@*Conclusion@#These findings confirm inequities in accessing outpatient and inpatient health services and utilizing health insurance benefits in the target population.

Scaling up primary health care in the Philippines: Lessons from a systematic review of experiences of community-based health programs

@#<p style="text-align: justify;"><strong>BACKGROUND:</strong> In view of renewed interest in primary health care (PHC) as a framework for health system development, there is a need to revisit how successful community health programs implemented the PHC approach, and what factors should be considered to scale up its implementation in order to sustainably attain ideal community health outcomes in the Philippines.</p><p style="text-align: justify;"><strong>OBJECTIVE AND METHODOLOGY:</strong> Using the 2008 World Health Report PHC reform categories as analytical framework, this systematic review aimed to glean lessons from experiences in implementing PHC that may help improve the functioning of the current decentralized community-level health system in the country, by analyzing gathered evidence on how primary health care evolved in the country and how community health programs in the Philippines were shaped by the PHC approach.</p><p style="text-align: justify;"><b>RESULTS:</b> Nineteen (19) articles were gathered, 15 of which documented service delivery reforms, two (2) on universal coverage reforms, three (3) on leadership reform, and one (1) on public policy. The literature described how successful PHC efforts centered on community participation and empowerment, thus pinpointing how community empowerment still needs to be included in national public health thrusts, amid the current emphasis on performance indicators to evaluate the success of health programs.</p><p style="text-align: justify;"><strong>CONCLUSION AND RECOMMENDATIONS:</strong> The studies included in the review emphasize the need for national level public health interventions to be targeted to community health and social determinants of health as well as individual health. Metrics for community empowerment should be developed and implemented by government towards sustainable health and development, while ensuring scientific validity of community health interventions.</p>

Community-managed health programs for better health outcomes: Preliminary results of a community participatory research in Murcia and Isabel, Negros Occidental, Philippines

@#<p style="text-align: justify;"><strong>BACKGROUND:</strong> Community-managed health programs (CMHPs) were designed to promote community self-determination in addressing health needs, but there is a need to evaluate how CMHPs can lead to better outcomes while accommodating changes in the national health system, which requires analysis of current CMHP interventions, institutional and community readiness, and points of interface with other health facilities.</p><p style="text-align: justify;"><strong>OBJECTIVE AND METHODS:</strong> This preliminary study aimed to guide an eventual effort to develop a framework to ensure CMHPs sustainably improve health outcomes. A preliminary analysis of results from a community participatory research was done in which baseline health characteristics, related social determinants, level of involvement of CMHPs with the local government health system, and quality of life were documented through surveys, focus group discussions and key informant interviews, both in a community with an established CMHP (Murcia, Negros Occidental, Philippines), and a control area without a similar NGO sector (Isabela, Negros Occidental).</p><p style="text-align: justify;"><strong>RESULTS:</strong> There was higher NGO and local government involvement among respondents in Murcia, use of traditional medicine, and sense of awareness of the need to improve the water quality in Murcia, with noted persistence of sanitation concerns, pinpointing the need to assess community participation and the efficiency of CMHPs.</p><p style="text-align: justify;"><strong>CONCLUSION:</strong> Further study is needed in measuring community participation while considering its underlying cultural and socioeconomic contexts, in order to facilitate planning and implementation of strategies that intend to address community-recognized health needs while sustainably improving health outcomes.</p>

Catalyzing development of best practice guidelines for community-managed health programs: Case study of a community-academic partnership

@#<p style="text-align: justify;"><strong>BACKGROUND:</strong> There is a need to standardize community health practices, while still adhering to principles of community involvement, to ensure social acceptability and equitable access to health services. A set of Best practice guidelines (BPGs) were thus developed through a community-academic partnership (CAP) between the Integrative Medicine for Alternative Healthcare Systems Philippines, Inc. and its affiliated community-managed health programs (CMHPs), the University of the Philippines, and Bicol University.</p><p style="text-align: justify;"><strong>OBJECTIVE:</strong> This study aimed to report the process and insights gained from the crafting of the BPGs.</p><p style="text-align: justify;"><strong>METHODS:</strong> The BPGs were developed using a community-based participatory research approach and focused on top ten (10) diseases based on local prevalence and experiences of its CMHPs.</p><p style="text-align: justify;"><strong>RESULTS:</strong> BPGs were developed for eight (8) communicable diseases (common cold/cough, influenza, measles, pulmonary tuberculosis, acute gastroenteritis, amebiasis, scabies, and intestinal parasitism); and two (2) noncommunicable diseases (diabetes and hypertension), which also provided information on signs and symptoms, initial referral criteria, management, and, where appropriate, specific use of medicinal plants, acupressure, and traditional massage. Emerging issues from this project include how community involvement led to the development of BPGs, the need to update its content, its potential application as a model for costing public health interventions, its anticipated benefits to health workers, the state of local health service delivery, and how the project epitomizes the ideal concept of community-academic partnerships.</p><p style="text-align: justify;"><strong>CONCLUSION:</strong> As a CAP project, this process holds promise as a catalyst for stakeholder engagement and health service delivery improvement. Further studies are necessary to map out other potential challenges and success factors, especially the socio-cultural, political, and health impact of CAPs.</p>