BACKGROUND: Underutilization of PhilHealth benefits undermines the effective distribution of public resources. To formulate effective strategies, the factors affecting the utilization of members must be studied.

OBJECTIVES: To (1) assess the rate of underutilization of inpatient benefits and (2) determine the association of chosen factors with PhilHealth underutilization of selected member groups in three barangays in Manila.

METHODS: The study was done in selected Barangays in Manila. Using the Expanded Program on Immunization (EPI) method of sampling, a sample size of 147 households were obtained and interviewed  for the study. An interview guide was used to gather the data needed for analysis. Chi-square test was then used to determine existing associations between underutilization and the chosen factors.

RESULTS AND CONCLUSION: The chi-square test of association revealed that gender (p-value=0.034), income (p-value=0.026), and type of membership (p-value=0.027) are significantly associated with underutilization. Females and paying members were found to be more frequent users. Gap between the utilization and underutilization rates was found to be greatest in the lowest income groups. 'Lack of knowledge on filing claims' (p-value<0.001) and on benefits (p-value<0.001) were also identified as significant predictors of underutilization. Results showing a significant proportion of household experiencing insurance underutilization highlight the need for NHIC to create new and/or improved mechanisms that will enable it to extend its reach to the people.

Human ; Male ; Female ; Middle Aged ; Adult ; Chi-square Distribution ; Filing ; Sample Size ; Inpatients ; Poverty ; Income ; Family Characteristics ; Insurance ; Immunization

: Contarini’s syndrome refers to the occurrence of bilateral pleural effusion which has different causes for each hemithorax. Based on extensive literature search, this is a rare finding and to date, only two published cases have recorded tuberculous effusion on one side. In this paper, the authors aim to present a case of Contarini’s syndrome, and to give emphasis that such condition with different etiologies exists and should be considered in managing bilateral effusion. : This is a case of a 69-year-old female with a 7-week history of dyspnea, 2-pillow orthopnea, fever, and right-sided chest discomfort. Patient sought consultation and was prescribed with Diclofenac and Cefalexin with no relief. Patient was then admitted and intubated due to worsening dyspnea. Patient was managed as COVID-19 confirmed critical with viral myocarditis, CAP-HR, and diabetic ketoacidosis. Initial chest x-ray showed right-sided pleural effusion. Thoracentesis was done and revealed exudative pleural fluid (PF) with WBC of 20,000 with neutrophilic predominance and negative RT-PCR MTB. Cytology revealed acute inflammatory pattern. Klebsiella pneumoniae ESBL was isolated. Antibiotics were shifted to levofloxacin and meropenem. Repeat chest x-ray showed left-sided pleural effusion. Thoracentesis was done and revealed exudative PF with WBC of 1,680 with neutrophilic predominance. No organism was isolated. RT-PCR for MTB was detected. Thus, anti-TB therapy was initiated. However, ETA TB culture showed resistance to isoniazid, rifampicin, and pyrazinamide. Patient was referred to PMDT for MDR-TB treatment. Bilateral effusion has resolved with no recurrence, and with uneventful removal of bilateral chest tubes. Patient was eventually extubated and transferred to the ward. Patient however developed HAP, was re-intubated and eventually expired due to the septic shock from VAP. This case report highlights the importance of weighing risk versus benefit in deciding to perform bilateral thoracentesis when there is a clinical suspicion of an alternate or concurrent diagnosis.
Pleural effusion ; Thoracentesis ; COVID-19