Is SARS-CoV-2 transmitted by asymptomatic and pre-symptomatic infected individuals?

Key Findings@#Asymptomatic and pre-symptomatic transmission of SARS-CoV-2 may occur. • Manifestations of COVID-19 are highly varied and may include asymptomatic cases, who do not manifest with any signs and symptoms despite testing positive for COVID-19 by viral nucleic acid tests. Pre-symptomatic cases are infected individuals who are still in their incubation period, hence do not exhibit any symptoms yet but eventually develop symptoms. • As of June 2020, only 586 (2.8%) of the 20,990 active cases in the Philippines were classified as asymptomatic, but it is unclear whether cases are pre-symptomatic or carriers (true asymptomatic). • Based on 36 observational studies (case reports, case series, cross-sectional and cohort studies) and 9 statistical modeling analysis, asymptomatic and pre-symptomatic transmission of SARS-CoV-2 may occur. However, 3 studies reported no transmission from pre-symptomatic and asymptomatic cases. • Studies on viral load comparing symptomatic cases with pre-symptomatic and asymptomatic cases reported contradicting results. The duration of viral shedding was significantly longer for symptomatic patients compared to asymptomatic patients but similar for asymptomatic and pre-symptomatic patients. • Therewas no difference in the transmission rates of symptomatic and asymptomatic cases. However,the estimated infectivity and probability of transmission was higherfor symptomatic cases compared to asymptomatic cases, but results were imprecise due to a wide confidence interval. • The World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) recognize the possibility of pre-symptomatic and asymptomatic transmission. According to WHO, current evidence suggests asymptomatic cases are less likely to transmit the virus than symptomatic cases.

Policy analysis on identifying copayment services for the shift in financing scheme of health care services

Background@#As the Philippines moves toward universal health coverage, it is imperative to examine how to eliminate inefficiencies, particularly misuse, overutilization, and risks of fraudulent claims. This position statement aimed to identify health services requiring copayments for cost-efficient health financing for the Universal Health Care Act. @*Methods@#A qualitative study was employed using a systematic review of literature, and thematic analysis of policy roundtable discussion (RTD) was conducted. The systematic review of literature generated evidence for the policy brief and critical points for discussion in the stakeholders’ RTD forum. The RTD was organized by the UP Manila Health Policy Development Hub (UPM HPDH) with the Department of Health (DOH) and was participated by key stakeholders of the policy issue to attain consensus recommendations and develop criteria for identifying services requiring copayments. @*Results@#An algorithm is proposed by the UPM HPDH based on collective expertise as a guide for policymakers to assess each benefit package in terms of overutilization, the danger of depleting government funds, and the risk of fraud. The use of clinical pathways is suggested to assess the misuse and overutilization of health services. In addition to copayments, benefits packages prone to fraudulent activities should be subjected to fraud prevention processes. Copayment should be linked inversely to the preventability level of the disease or condition. @*Conclusion@#There were gaps in the current policies to identify services requiring copayment services. Copayment schemes should be carefully determined to prevent misuse, overuse, and fraud of appropriate and necessary health services, while at the same time not limit access to needed care.

Rationalizing health personnel financing schemes for evidence-informed policy reforms: Policy analysis

Background@#The Universal Health Care Law seeks to optimize financing of personnel costs without compromising quality and equitable health care among the health care facilities. This position statement aimed to identify strategies and policy recommendations for the cost-effective financing of health personnel in public healthcare facilities. @*Methods@#A systematic review of literature was done to generate policy brief and key points for roundtable discussion in collaboration with the Department of Health (DOH). The discussion was guided by the three health financing options of DOH: (a) retain Personnel Services (PS) as DOH budget but shift Maintenance and Other Operating Expenses (MOOE) to PhilHealth; (b) shift PS and MOOE to PhilHealth, and (c) rationalize part-time status in government hospitals. @*Results@#The pros and cons of financing options were cross-examined. In Option 1, physicians in government hospitals would receive fixed salaries from DOH / Local Government Units. In Option 2, there would be a monopsony between PhilHealth and provincial power. Payment will be performance-driven, and balance billing will be eliminated. Option 3 would be a set up of retaining part-time positions for physicians. @*Conclusion and Recommendation@#Participants deduced that for Option 1, provision of salary augmentation sources and ensuring adequate plantilla items and level of remuneration in government hospitals should be considered, in order to sufficiently compete with physicians’ income from private practice. For Option 2, the PhilHealth reimbursement system should ensure timely reimbursement so as not to subject care providers to financial instabilities. For Option 3, rationalizing part-time status should be flexible and can be applied regardless of how physicians are paid, as this would incentivize caregivers to work harder and smarter.