The migration "carousel" for health workers - or human resources for health (HRH) - is a phenomenon ripe with opportunities and difficulties for its many stakeholders. With an in-depth literature review, the situation is put into context, in terms of the underlying factors that prompt workers to relocate, as well as the facilitating effects of globalization and worldwide HRH shortages. The possible outcomes are discussed, particularly the externalities that relate to source and recipient countries. The actual impact of worker shortages on the delivery of health care is further clarified. Policy options for modulating HRH flows and enhancing HRH stocks are thereafter drawn. Individual as well as country interests are taken into consideration in deriving a range of applicable policy instruments. Managed migration schemes for HRH flows appear to provide the greatest flexibility for most concerned parties. The application of the derived policy framework in a leading HRH "donor" country, the Philippines, is presented. 

Human ; Male ; Female ; Philippines ; Health Personnel ; Delivery Of Health Care ; Policy ; Internationality

Appendicitis is the most frequent indication for emergent surgery in children. Appendectomies are increasingly done laparoscopically, minimizing tissue trauma and enabling earlier recovery, but the added costs remain prohibitive in resource constrained settings. An open approach, but from a less conspicuous inguinal incision, provides similar advantages without additional resource requirements. The operative technique is described and the profile of patients, including their clinical course and operative findings, are summarized. The differences in short-term outcomes for non-perforated and perforated cases are compared. The trans-inguinal approach was utilized in 26 patients. It provided adequate surgical access even for ruptured cases and had suitable wound outcomes. Ruptured cases had significantly longer operative time, but were not associated with differences in the patients' length of stay.
Appendectomy ; Appendicitis

Introduction: The National Telehealth Service Program (NTSP) has developed Information Technology (IT) systems aimed at improving health services primarily in isolated Philippine communities. These included two electronic health records modalities (Community Health Information Tracking System, or CHITS, and Real-time Regular Routine Reporting for Health, or R4Health), a referral system (Telemedicine), and a remote diagnostic device (RxBox). Objectives: This study was undertaken to describe the utilization and cost patterns as well as the perceptions of the local health personnel regarding the use of the various NTSP systems. The implications of the end-user perceptions on the acceptability and expanded use of the IT interventions were inferred, from which corresponding policy recommendations were made. Methods: Twelve NTSP sites, including far-flung and economically depressed communities, where the systems were concurrently available over a defined six month period, were selected. The frequency of respective system transactions for these sites was collected from NTSP files. Interviews and focus group discussions were conducted at the communities, involving physicians, nurses, midwives, and other health workers. Associated costs, and perceptions related to the adoption, operation, and sustained use of the IT systems were elucidated. Results: Telemedicine, though the least costly modality, was the least utilized of the systems. While both R4Health and CHITS facilitated health data management, CHITS provided more locally-relevant information. The RxBox system, due to its clinical diagnostic device component, was widely accepted and also increased health center consultations, especially among pregnant patients. Technical malfunctions, as well as system failures following natural calamities, were recurrent problems. Conclusions The RxBox system, with its bundled health records and specialist consultation functions, is highly accepted by health providers and other community stakeholders. The technology can be expected to be similarly well-regarded in other settings. The stand-alone IT modalities that do not directly or significantly benefit the actual implementers are not as sustainable.
Electronic Health Records ; Information Technology ; Telemedicine

The use of a locally prepared polyethylene glycol electrolyte lavage solution (PEG-ELS) for preoperative bowel preparation of pediatric patients undergoing colostomy/ileostomy closure was compared with a standard three day regimen.Twenty-three patients were randomly assigned to either PEG-ELS or a standard three day bowel preparation, For both groups,? there were no significant differences in the changes in the pre and post-prep body weights, hematocrit, and serum electrolytes.Patients did not exhibit? abdominal cramps nor vomiting with either preparation. Intra-operative assessment showed adequate cleansing of bowels in both procedures. Postoperative complications were?not related to the preparations.? This study shows that using a locally prepared polyethylene glycol?electrolye lavage solution may be an excellent alternative to the standard?three day bowel preparation in pediatric patients.

Human ; Male ; Female ; Ileostomy ; Colostomy ; Therapeutic Irrigation ; Polyethylene Glycols ; Colic ; Hematocrit ; Vomiting ; Postoperative Complications ; Cathartics

Background: Tiered services, differentiated by the financial capacity of patients and related payment arrangements with hospitals, are the norm in Philippine facilities. This study considered how these, together with selected demographic and clinical factors, were associated with surgical care utilization, provision, and outcomes for patients with appendicitis in a public university hospital.

Methods: This was a retrospective cohort study, utilizing data obtained from an electronic patient registry. Patients who underwent emergent appendectomies from January 2017 to December 2018 were included. Data were analyzed using multivariate and logistic regression, with the following dependent variables: time from symptom onset to emergency department consultation (ED Lag), time from consult to surgery (OR Lag), selection for laparoscopic appendectomy (LA), the occurrence of complicated appendicitis (CA), and length of stay (LOS). Morbidities and mortalities were tallied.

Results: There were 1,501 patients included in the study. Young adult males comprised the majority and mostly had non-private accommodations. Non-CA was the impression in more than 80% of cases. Extremes of age were associated with longer ED and OR Lags, greater likelihood of CA, and longer LOS. Patients initially assessed as having CA had shorter OR Lags, were less likely to undergo LA, and had longer LOS. Private patients were more likely to have undergone LA, lower CA odds, and slightly longer LOS.

Conclusions: Variations in surgical care utilization, provision, and outcomes for patients with appendicitis were independently associated with socioeconomic and clinical status differences.

Health Services Accessibility ; Appendicitis ; Laparoscopy ; Outcome Assessment, Health Care ; Socioeconomic Factors

Reported here is the first documented laparoscopic repair of a rare partial diaphragmatic eventration in a pediatric patient. The case involves a three year old female who had recurrent cough. While a Morgagni hernia was the initial impression, an eventration of the left anterior diaphragm was instead found on laparoscopy. Repair was aided by using transcutaneous traction, with plication achieved by intracorporeal sutures. The patient recovered uneventfully and follow-up x-ray after six months demonstrated an intact repair.
Diaphragmatic Eventration ; Hernia, Diaphragmatic ; Laparoscopy

<b>BACKGROUND:b> The Philippine Health Insurance Corporation (PhilHealth) has adopted several computer-based systems to enhance claims processing for hospitals.

OBJECTIVES: This study sought to determine the efficiency gains in the processing of PhilHealth claims following the introduction of computer-based processing systems, taking into account differences in hospital characteristics.

METHODS: Data were obtained from a survey conducted among 200 hospitals, and their corresponding 2014 claims figures as provided by PhilHealth. Summary descriptive statistics of hospital capacities (ownership, service level, and utilization of PhilHealth computer systems) and claims outcomes (claims rejection rates, as well as length of claims processing times for hospitals and with PhilHealth) were generated. Multivariate regression analysis was done using claims outcomes as dependent variables, and hospital capacities as independent variables.

RESULTS: Nearly a quarter of the surveyed hospitals did not utilize any of PhilHealth's computer-based claims systems. Utilization was lowest for primary as well as public facilities. Among those that used the systems, most employed the on-line membership verification program. The mean claims rejection rate was 3.81%. Claims processing by hospitals took an average of 35 days, while PhilHealth required 40 days from receipt of claims to the release of reimbursement. Regression analysis indicated that facilities that utilized computers, as well as private hospitals, had significantly lower claims rejection rates (p<0.05). The claims processing duration was significantly shorter among private facilities.

CONCLUSIONS: Private hospitals are able to process claims and obtain reimbursements faster than public facilities, regardless of the use of PhilHealth's computer-based systems. PhilHealth and public hospitals need to optimize claims processing arrangements.

Human ; Insurance Claim Review ; Philippines

Background: In the continuity of care, family and community physicians take into consideration patient insurance coverage, especially for those who require higher levels of care. The Philippine Health Insurance Corporation (PhilHealth) has had its electronic reimbursement claims processing since 2011 but the utilization of this system by hospitals may be affected by delays in claims reimbursement. Factors associated with such delays warrant further investigation. Objectives: This study aimed to determine the perceived factors by concerned hospital staff that affect delays in PhilHealth’s electronic claims processing system. Methods: Three focus group discussions (FGDs) were conducted using a predetermined set of questions. The hospitals were selected from respondents of a survey of a bigger study on the applicability of PhilHealth’s electronic claims processing. Each FGD involved eight-to-ten participants, mostly PhilHealth officers or information technology personnel from different hospitals covering Luzon, Visayas, and Mindanao. The hospitals were of different types/levels and included both government-run and privately-owned. Results: Factors affecting delays in electronic claims reimbursement are intrinsic to the hospitals’ operations, with delays in obtaining the physician’s signature as the most common cause. Accessing PhilHealth’s server was another major factor and was aggravated by problems in clarifying patient eligibility, non-updated data, and variations in the emphasis of regional evaluators. Hospitals within the national capital region and those using their own electronic medical records and health information system had better experiences with the electronic claims reimbursement. Conclusions The main factors affecting delays in electronic claims reimbursement among hospitals are associated with the hospitals’ institutional processes. The active participation of family physicians and primary care providers can help address these issues and subsequently improve service delivery, PhilHealth utilization, and overall patient satisfaction.
Electronics ; Humans ; Surveys and Questionnaires

Introduction. The COVID-19 pandemic has not only resulted in a public health crisis but has also strained hospital services. The provision of surgical care should therefore also be guided by ethical, and whenever applicable, also legal, principles. Methods. An integrative approach that covers clinical and ethical dimensions, as well as spans the spectrum of surgical care, is therefore necessary. This action research involved three key steps: 1) identification of ethical dilemmas related to the provision of surgical care during the COVID-19 pandemic; 2) preparation of clinical scenarios that highlight these dilemmas; and 3) determination of the appropriate options for the said scenarios, based on the best available evidence as well as most applicable ethical principles. Results. Ethical theories included utilitarianism, human rights, and communitarianism. Ethical principles included non-maleficence, justice, autonomy, and beneficence. Values considered were duty, reciprocity, human life, efficiency, fairness, fidelity, ownership, social value, and fair innings. Also incorporated were informed consent, allocation principles, resource allocation, and triage. In terms of operational issues and surgical technical concerns, the following were considered: phased standards of care, categorization of interventions, prioritization, surgical approaches, infection control, diagnostics, patient welfare, staff welfare, operations protocols, surgical training, and communication. Key points derived from the ethical and technical considerations of surgical care delivery during the COVID-19 pandemic are presented. Conclusion. This action research involving a review of the literature and stakeholder engagement has provided a concise ethical and technical resource for surgical administrators, practitioners, and trainees.
COVID-19 ; Pandemics