Thirty-seven Filipino children die of pneumonia daily, and 90% of those who die are under 5 years old.1 More than 50% of childhood pneumonia is readily treatable with antibiotics; however, only 31% of children with pneumonia receive the antibiotics they need.2 From 2016 to 2018, pneumonia and acute lower respiratory tract infection (ALRTI) comprised the 3rd leading cause of morbidity in the Philippines across all age groups. In 2018, there were 213,611 reported cases of pneumonia and ALRTI among Filipino children <5 years old.3 In 2011, the Philippine Health Insurance Corporation (PhilHealth) created case rate packages for selected medical procedures and medical conditions, including pneumonia. A case rate is a fixed amount that PhilHealth pays to a health care provider for the diagnostic and therapeutic care of a patient with a particular disease or condition. The case rates for moderate-risk and high-risk pneumonia are PHP 15,000 and PHP 32,000, respectively.4 PhilHealth also introduced a no-balance-billing (NBB) policy, applicable to all PhilHealth Sponsored Program members and/or their dependents when they seek health care in a government hospital for diseases or conditions included in the case rate packages. The policy provides that government hospitals shall not charge other fees or expenses beyond the case rate to patients covered by the policy.4 Given the high incidence of pediatric community-acquired pneumonia (PCAP), policies that support current efforts in attaining adequate financial protection of patients--or their families--would certainly improve health outcomes related to the disease. The aim of this article is to recommend health policies based on the results of a study on health insurance coverage of patients with PCAP.

BACKGROUND

The COVID-19 pandemic had a profound impact on medical education, particularly in Family and Community Medicine training programs. This study aimed to assess the impact in the Philippines by comparing the number of cases and procedures before and during the pandemic, as well as the adaptations made by these programs.

The objective of this study was to determine the effect of the COVID-19 pandemic on Family and Community Medicine training in the Philippines by comparing the average number of cases and procedures done before and during the pandemic and the changes implemented by the different accredited training programs.

A cross-sectional study utilizing an explanatory sequential mixed methods approach was undertaken. The quantitative portion collected data on cases and procedures from the participating institutions’ residents using the standardized checklist of the Philippine Academy of Family Physicians. The qualitative portion was done through a focused group discussion (FGD) following a prepared set of FGD questions. Analysis of variation (ANOVA) was used to compare the average cases seen and procedures across the four years and content analysis for the qualitative data.

There was a significant decrease in the average number of adult and pediatric cases during the pandemic years (2020-2021) compared to before (2018-2019). Various organ systems cases such as neurology, ophthalmology, dermatology, and gastrointestinal, showed significant differences (p-value<0.05) were found for several organ system cases when comparing the years before (2018-2019) and during the pandemic (2020-2021), including neurology, ophthalmology, ENT, dermatology, cardiology, gastrointestinal, genitourinary, reproductive health, musculoskeletal, and endocrinology cases. The trainers adjusted training activities to support the hospital's COVID-19 response and that prompted an abrupt shift to online strategies for patient consultations, teaching sessions, and examinations.

The COVID-19 pandemic led to a reduction in the variety of cases and procedures in Family and Community Medicine training, impacting the fulfillment of specialty training requirements. However, it also drove innovation through the integration of technology, including online teaching methods. These experiences underscore the importance of resilience and adaptability in medical education and offer valuable lessons for future training programs, potentially leading to improvements in training and patient care through innovative methodologies.

BACKGROUND: In 2016, the Philippine Health Insurance Corporation (PhilHealth) introduced the Z-package to provide financial coverage for, among others, intramedullary nailing procedures and implant costs for eligible patients with femoral shaft fractures. OBJECTIVE: To compare health care durations and expenses between patients with closed femoral shaft fractures requiring intramedullary fixation who utilized the PhilHealth Z-package and those who did not. DESIGN: Retrospective cohort study. PARTICIPANTS: 66 male and female patients, aged 19 to 39 years, who underwent intramedullary nailing for closed femoral shaft fractures. SETTING: Orthopedic Ward, Southern Philippines Medical Center, Davao City, January to December 2018. MAIN OUTCOME PROCEDURE: Time to surgery, length of hospital stay, total hospital bill, total PhilHealth coverage, other funds for medical assistance (OFMA) coverage, and out-of-pocket (OOP) expenses. MAIN RESULTS: Among the 66 patients, 33 had the Z-package, while the remaining 33 did not. The median time to surgery (19 days vs 24 days; p=0.156), median length of hospital stay (24 days vs 29 days; p=0.546), and median total hospital bill (Php 62,392.00 vs Php 62,404.80; p=0.314) were comparable between those without the Z-package and those who had, respectively. However, patients without the Z-package had significantly lower total PhilHealth coverage (Php 30,740.00 vs Php 48,740.00; p<0.001) and higher OFMA coverage (Php 49,909.90 vs Php 34,409.20; p=0.024), and OOP expenses (Php 0.00; IQR: Php 0.00 to Php 20,000.00 vs Php 0.00; IQR: Php 0.00 to Php 0.00; p=0.004) compared to those with the Z-package. CONCLUSION Patients with the Z-package had a slightly longer time to surgery, although this difference was not statistically significant. However, they benefited from significantly lower remaining bills after PhilHealth coverage and reduced OOP expenses compared to patients without Z-package coverage.
PhilHealth coverage ; out-of-pocket expenses ; medical assistance ; length of stay

The Southern Philippines Medical Center (SPMC) is the tertiary hospital in Davao City that is fast becoming a world-class, service-oriented medical center, leading in the provision of health care and training in Mindanao. For a century now, SPMC underwent several processes of reinvention in order to meet the changing needs of the public we serve. Between the years 1917 and 1920, Davao Hospital started operations in a temporary wooden pavilion originally built by the Bureau of Public Works for its sick laborers. The temporary hospital was equipped with basic equipment and had a small laboratory. The government of the Philippine Islands allocated budget for the salaries of one resident physician, one superintendent and property clerk, three nurses, four ward attendants, one cook, one assistant cook, and five laborers-a total of 16 personnel-to keep the hospital running. Over the succeeding decades, the Davao Hospital underwent several name changes, with corresponding increases in bed capacity from 50 in 1921 to 1200 in 2009. The hospital also slowly provided specialized health care services to cater to the growing needs of the populace. Starting in the 1950s, the hospital's services were divided into specialty areas, and the establishment of residency training programs in different medical disciplines soon followed. The services also became more specialized and sophisticated with the establishment of a burn unit, a heart center, a dialysis center, and a kidney transplant unit. We are an “accomplished” old institution. It is very tempting to go gentle into that good night and rest on our laurels. However, resting on previous achievements is definitely not an option. Prior success does not always guarantee continued results.
Physicians ; Internship and Residency

The growing problem of child sexual abuse (CSA) in the country has led the government to establish a set of standards for the delivery of hospital-based services to the survivors, in order to ensure that their needs are addressed promptly and effectively. Hence, the establishment of Women and Children Protection Units (WCPU) in all Department of Health (DOH) hospitals was mandated through a department administrative order.1 However, many WCPUs across the country are beset with problems such as inadequate facilities and equipment, and a scarcity of full-time service providers with proper training to handle survivors of CSA.2 These problems impede the delivery of optimal services required in managing clients in the WCPU.
Child Abuse, Sexual ; Survivor ; Child ; Female

Readiness of Health Care Staff: Statement 1. Family physicians and their staff should prepare themselves mentally, physically and emotionally before resuming clinic services. Prior to starting every clinic day, physicians and their staff should take their temperature and note respiratory symptoms. Statement 2. All clinical staff should be properly trained on proper use of PPEs, clinic disinfection, infection control and other safety procedures. Statement 3. Family Physicians should design an office management and operations plan that includes triage, patient flow, treatment and other patient care protocols including strict implementation of infection prevention and control procedures, management of PPE supplies and potential staff shortages. Statement 4. The clinic staff must inform their patients of the changes that may result from the new management and operations plan that will be made in the facility Clinic Procedures, Disinfection and Infection Control: Statement 5. After undergoing proper triage, non-COVID 19 patients entering the clinic should use a hand sanitizer, step on a foot bath or pad soaked in chlorine or any approved disinfectant solution at the entrance. All clinic staff, patients and accompanying persons should be wearing at least a mask inside the clinic. They should be instructed to avoid touching their face or mask and perform hand hygiene immediately before and after if cannot be avoided. Statement 6. Appropriate visual alerts or educational posters regarding infection control, proper handwashing, cough or sneezing etiquette should be visible inside the clinic. Statement 7. The clinic facility must have infection prevention and control measures that adhere to international and local standards. Statement 8. After appropriate triaging, a family physician when attending to a patient shall wear mask, single use gloves and eye protection while apron or gown is optional. It is up to the discretion of the family physician to use higher level of protection based on his risk assessment of the clinic environment and if resources are available. Clinical Services Statement 9. As much as possible, family physicians should continue all primary care services in the clinics. However, it is advisable to first limit the service to non-COVID-19 (suspect or diagnosed) patients. Patients needing COVID-19 assessment and management should be referred to appropriate facilities and follow the guidelines set forth by the Department of Health. Statement 10. A patient who consulted and whose symptoms were resolved may choose not come back for follow-up. Patients with chronic diseases may be followed-up at longer intervals if their illness is stable. Statement 11. Referrals for further assessment, diagnostic tests, or other procedures not available in the clinic must first be coordinated with the referral center/site
Personal Protective Equipment ; Triage ; Disinfection