Primary care services in the UHC: Cost identification study

Background@#In order to financially sustain the participation of the private sector in the UHC, there is a need to find reasonable balance of accountability in the costing of health services. The costing must be based on actual resources used from the perspective of the private health service provider. @*Objective@#The objective of this paper was to determine the cost of primary care services from the framework of the UHC reform in the private sector.@*Method@#This is a multi-method approach to cost-identification in establishing and providing primary care health service in the UHC. The approaches used by the authors included review of published literature, laws and policies from DOH and other regulatory agencies. From this review, they develop the minimum facility requirement for basic primary care facility and primary care facility with ancillary services. They used the actual expenditures of existing primary care clinics, 2021 quotations from equipment and supplies companies, published construction rates and consensus approach to establish the cost. Based on 2021 value of Philippine Peso, they estimated the cost of constructing and operating a primary care facility.@*Results@#The total estimated cost of building a primary health care facility based on the DOH licensing standard was estimated to be around PhP2,490,000. The cost of furniture and equipment as required in the DOH AO was PhP474,685. Thus, the total cost of the construction and equipment for a basic primary care facility setup is PhP2,964,685. We estimated the annual operating cost with the building estimated to depreciate in 20 years and the furniture and equipment in 5 years, the annualized cost for the building is PhP124,500 and for the furniture and equipment PhP94,937. The total annual salary of the staff based on government standards was PhP2,381,962. The maintenance, operating and overhead expenses (MOOE) which included water and electricity, repair and maintenance, waste disposal, supplies and other fees was PhP451,190. The total annual operating cost of a basic primary care facility is PhP3,052,590. This facility can provide basic services such as outpatient consultation and minor surgeries. Using the same approach for the basic facility, the total annual operating cost of a basic primary care facility with ancillary service is PhP11,023,670. This facility can provide outpatient consultation, minor surgeries and primary care services such as health education and preventive care plus the ancillary services like pharmacy, clinical laboratory and x-ray. For patients with diabetes, the total annual cost is PhP8,986. The significant cost driver is the clinical assessment and non-pharmacologic intervention. The researchers found the same cost pattern for the annual cost care of patients with hypertension but with a slightly higher annual total with PhP9,963. Their sensitivity analysis based on inflation, construction, equipment and operating expense may increase these cost estimates by 20% in the next 5 years. @*Conclusion@#Based on their findings, the current per capita support from PHIC Konsulta package is not adequate in the private sector both for wellness and care of patients with chronic condition. PHIC needs to consider adjusting per capita rates and consider case rate payment as it is currently doing for hospital care. Without this proposed adjustment, only those patients in the higher socioeconomic status will be capable of consulting the private sector. This scenario defeats the equity issue that is a primary concern in the UHC.

Informing patients about disease prognosis

@#Prognosis refers to the development of possible “outcome” of disease i.e., survival in patient with cancer. Prognostic factors are characteristics of a particular patient that can be used to predict that patient’s eventual outcome i.e., patients with advanced TNM cancer stage may have lower probability of survival than those with less advance TNM cancer stage. Thus, prognosis is a prediction of the probable outcome of a disease based on a individual’s condition and the usual course of the disease as seen in similar situations. Family physicians are often asked by patients about the probable course of their disease, they need skills on how to inform patients about this.

Using a clinical practice guideline for making clinical decisions

@#Clinical practice guideline is defined as “statements that include recommendations intended to optimize patient care that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options”. It includes recommendations that are intended to optimize patient care. They are the best source of evidence for busy clinicians and may be the most efficient type of evidence to guide decision making in family practice.

Continuous quality improvement for family and community practice in UHC

@#Quality health care is one of the central themes in the reform areas of the Universal Health Care (UHC). But in low- and middleincome countries like the Philippines, quality of health care is suboptimal. There are several challenges in implementing quality improvement in family and community practice. These include a weak health system arising from inadequate human resource and capacity, low utilization of data for health care improvement, and minimal involvement of patients to demand better quality and safety. There are also barriers, such as lack of access to evidence-based medicine resources, poor insurance systems compound the complexity of addressing health care quality. While the PAFP has already done these trainings in the past and available experiences on primary care CQI initiatives published in the local literature, in this article, we propose simple steps in line with what may be the requirement of the UHC reform.