The cost of primary care: An experience analysis in an urban setting

Objectives@#PhilHealth’s present health benefit scheme is largely centered on in-patient services. This inadvertently incentivizes hospital admissions for increased access to benefit coverage. To address this problem, this study proposes a costing method to comprehensively finance outpatient care. The objective of this paper is to estimate an annual primary care benefit package (PCBP) cost based on experience analysis (actual benefit usage) on the first year of implementation at an urban pilot site. @*Methods@#A cost analysis was conducted to assess a disease-agnostic primary care benefit package for an urban outpatient government facility over the first year of implementation. Costing information was gathered through staff interviews, accounting documents, and usage data from the electronic health records system available on-site. @*Results@#The annual primary care cost was defined as the estimated financial coverage for eligible employees and their eligible dependents (n=15,051). The annual utilization rate for consultations was reported at 51%. Of patients who consulted, approximately 38% accessed free available diagnostic procedures and 48% availed of free available medicines. Based on these usage rates, the annual primary care cost for the first year was computed at PhP 403.22 per capita. @*Conclusion@#Our study shows that on the first year of coverage in a government run urban outpatient facility, an allocation of PhP 403.22 per capita can allow coverage for a disease-agnostic package (comprehensive); this amount excludes out-of-pocket expenses incurred by the target population of this study. This amount is feasible only when coopted with opportunistic registration, reduction of untargeted check-ups, prior contextual community engagement, and streamlining of patient-transactions through an electronic health record (EHR).

Sobre a enunciação de mulheres não brancas na ciência: uma análise da produção intelectual de Gloria Anzaldúa e bell hooks / On the enunciation of nonwhite women in science: an analysis of the intellectual production of Gloria Anzaldúa and bell hooks / Sobre la enunciación de las mujeres no blancas en la ciencia: un análisis de la producción intelectual de Gloria Anzaldúa y bell hooks

O presente trabalho busca investigar a fala/silêncio de mulheres de cor na produção científica e estabelecer uma discussão em torno do lócus enunciativo do sujeito subalterno na vida social contemporânea no campo científico. Foram analisados os textos "Intelectuais Negras", de bell hooks, e "Falando em línguas: uma carta para as mulheres escritoras do Terceiro Mundo", de Gloria Anzaldúa. Também foram tomadas as contribuições de Gayatri Spivak (2010) no texto "Pode o subalterno falar". As análises apontaram que as teóricas estudadas buscam novas estratégias epistemológicas e estabelecem um diálogo crítico com distintas correntes do pensamento. As mulheres, até agora produzidas como objetos do saber, reclamam a produção de um saber local, sobre si mesmas; assim, transitam entre o silêncio e a fala, entre a ausência de uma produção audível e a denúncia de uma história invisível em uma ciência imperialista.

The present work seeks to investigate the speech/silence of colored women on the scientific production, having as its objective to establish a discussion around the enunciative locus of the subaltern subject on the contemporary social life, in the scientific field. We analyzed the texts "Black Intellectuals" written by bell hooks and "Speaking in tongues: a letter to the women writers from the third world" written by Gloria Anzaldúa were analyzed. The contributions of the text "Can the subaltern speak", by Gayatri Spivak (2010), was also used. The analysis points out that the studied writers are seeking new epistemological strategies, establishing a critical dialogue with distinct fields of thought. Women, so far produced as "knowledge objects" claim the production of local knowledge about themselves. So, they transit between the silence and the speech, between the absence of an audible production and the uncovering of an invisible history in an imperialist science.

El presente trabajo busca investigar el habla/silencio de mujeres de color en la producción científica, se tiene como objetivo como reto establecer una discusión sobre el lócus enunciativo del sujeto subalterno en la vida social contemporánea, en el campo científico. Desarrolló el análisis de los textos "Intelectuales Negras" de bell hooks y "Hablar en lenguas: carta a las escritoras del Tercer Mundo" de Gloria Anzaldúa. Las aportaciones de Gayatri Spivak (2010) en el texto "¿Puede hablar el sujeto subalterno?". El análisis apunta que las teóricas estudiadas buscan nuevas estrategias epistemológicas, establecen dialogo crítico con distintas corrientes del pensamiento. Las mujeres, que hasta el momento eran objetos del saber, reivindican la producción del saber local, un saber acerca de sí mismas. Así, ellas transitan entre el silencio y el habla, entre la ausencia de una producción oíble y la denuncia de una historia invisible en la ciencia imperialista.