The cost of primary care: An experience analysis in an urban setting
https://doi.org/10.47895/amp.vi0.6589
- Author:
Mia P. Rey
1
;
Regine Ynez H. De Mesa
2
;
Jose Rafael A. Marfori
2
;
Noleen Marie C. Fabian
2
,
3
;
Romelei Camiling-Alfonso
2
;
Ramon Pedro P. Paterno
4
;
Nannette B. Sundiang
2
;
AB Yusoph
5
;
Leonila F. Dans
6
;
Cara Lois T. Galingana
2
;
Ma. Rhodora N. Aquino
2
;
Josephine T. Sanchez
2
;
Jesusa T. Catabui
7
;
Antonio Miguel L. Dans
8
Author Information
1. Virata School of Business, University of the Philippines Diliman, Quezon City, Philippines
2. Philippine Primary Care Studies, Center for Integrative and Development Studies, University of the Philippines Diliman, Quezon City, Philippines
3. College of Nursing, University of the East Ramon Magsaysay Medical Center, Inc., Quezon City, Philippines
4. National Institutes of Health, University of the Philippines Manila, Manila, Philippines
5. Department of Accounting, Bocconi University, Milan, Italy
6. Department of Pediatrics, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
7. University Health Service, University of the Philippines Diliman, Quezon City, Philippines
8. Department of Medicine, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
- Publication Type:Journal Article
- Keywords:
Experience analysis
- MeSH:
Healthcare Financing;
Costs and Cost Analysis;
Primary Health Care
- From:
Acta Medica Philippina
2024;58(Early Access 2024):1-12
- CountryPhilippines
- Language:English
-
Abstract:
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).
- Full text:8317-Article Text-143164-1-10-202402021.pdf
