<p style="text-align: justify;">OBJECTIVES: To determine the level of satisfaction with the National Health Insurance Program (NHIP) among PhilHealth-accredited members of the four different medical societies (PCP, PPS, PCS and PSA) and identify areas for improvement of the NHIP.p> <p style="text-align: justify;">METHODS: In 2006, UPM-NIH conducted satisfaction surveys among PhilHealth-accredited members of the Philippine College of Physicians (PCP), Philippine Pediatric Society (PPS), Philippine College of Surgeons (PCS), and Philippine Society of Anesthesiologists (PSA) during their respective national conventions. The survey questionnaire used a Leikert scale to measure level of satisfaction and was based on the key performance areas of the NHIP identified in the validation framework of the InterAgency Validation Team and key informant interviews (KIIs) of selected medical doctors. Data analysis was done using SPSS ver 14.p> <p style="text-align: justify;">RESULTS AND CONCLUSION: Respondents from the PCS (surgeons) were only slightly satisfied with PhilHealth in general, while the respondents of the other three societies: (PCP - Internists, PPS - Pediatricians, and PSA - Anesthesiologists) were slightly dissatisfied with PhilHealth. Respondents of the four societies were satisfied with the accreditation process. Respondents were most dissatisfied with the length of time to be reimbursed and the amount reimbursed for their professional services. The respondents from the PCS tended to be more satisfied than the respondents of the PCP, PPS and PSA. Respondents expressed some dissatisfaction with the PhilHealth benefit package formulation. A significant percentage of respondents (about 27%) were neither satisfied nor dissatisfied with PhilHealth. These respondents could swing PhilHealth satisfaction either way and PhilHealth should make efforts to make them satisfied.p> <p style="text-align: justify;">The design of the survey tool precluded a qualitative analysis of the reasons for satisfaction/dissatisfaction. But the areas of most dissatisfaction identified by the respondents have to do with reimbursement: length of time and amount. In subsequent small group discussions with different physician service providers, it was observed that there was a general low level of awareness about the principles of social health insurance, benefit design and payment mechanisms. PhilHealth should address this with regular information and service improvement campaigns to engender a more proactive role for the service providers in achieving greater financial access to needed quality health services for all Filipinos.p> <p style="text-align: justify;">Respondents had recommendations to improve PhilHealth performance in the following areas: accreditation, reimbursement, SPECIAL ARTICLE benefit package formulation, administrative process, and coverage and enrollment. Many of the recommendations had to do with increasing PhilHealth efficiency, unifying the Department of Health (DOH), the Philippine Regulatory Commission (PRC) and PhilHealth standards, simplifying and decreasing requirements for the different processes and improving PHIC's information system. They also recommended revising the relative value scale (PhilHealth's system of assigning a value to a certain procedure which serves as the basis for determining the amount for reimbursement), improving coverage, formulating comprehensive benefit packages focused on the poor, and effective identification of the poor for the Sponsored Program, (PhilHealth's program for enrolling the poor).p>
Human ; Male ; Female ; Relative Value Scales ; Anesthesiologists ; Philippines ; Social Security ; Insurance, Health ; Pediatricians ; Surgeons ; Societies, Medical

<p style="text-align: justify;">OBJECTIVE: As there is a dearth of information on phyllodes tumors of the breast in the Philippines yet this ultimately impacts on the management and survival of Filipino patients, the authors reviewed their surgical cases of phyllodes tumors, focusing in this report, for the first time in Philippine literature, on the real risk of distant metastasis from the more common benign variety of phyllodes tumors. They therefore aim to identify case/s and do a review of literature on distant metastasis from benign phyllodes tumors.p><p style="text-align: justify;">METHODS: A review of records of all surgical cases of phyllodes tumor managed at PGH from 2005 - 2014 was done. Data from patients who on follow up were found to have distant metastasis were gathered and further reviewed. A literature search on metastatic phyllodes tumor and its implications was likewise done to complete this study.p><p style="text-align: justify;">RESULTS: A total of 200 patients with phyllodes tumor surgically managed within the study period were reviewed and followed up. One hundred sixty one out of 200 (80.5%) patients were histologically classified as benign. Twelve patients out of 200 (6.0%) developed distant metastasis on follow up, 1 (0.62% of 161 benign phyllodes tumors) of whom had benign phyllodes tumor.p><p style="text-align: justify;">CONCLUSIONS: The authors show that distant metastasis from benign phyllodes tumor can occur here in the Philippines. Therefore, the subtype of phyllodes tumor alone, especially in benign lesions, does not absolutely predict biological behavior and risk of recurrence. A better understanding of the true nature of metastasis in these tumors is highly anticipated.p>
Human ; Male ; Female ; Phyllodes Tumor ; Breast ; Risk ; Neoplasm Recurrence, Local ; Breast Neoplasms

Necrotizing fasciitis of the breast is a rare but potentially fatal soft tissue infection. It may occur primarily in patients without any direct cause, and less commonly after undergoing elective surgical procedures such as cosmetic mammoplasties and oncologic resections. This is a case of a 46-year-old female with stage IIIA invasive ductal carcinoma of the left breast treated with modified radical mastectomy presenting with a necrotizing infection involving the bilateral breast regions and left lateral abdomen six days after operation. She was managed with broad-spectrum antibiotics and radical debridement with right mastectomy, followed by wound coverage with split-thickness skin grafting. This is the eight case of breast necrotizing fasciitis occurring after mastectomy for breast cancer reported in the literature.
breast ; fasciitis, necrotizing ; mastectomy, modified radical