Background: Philippines is in a constant struggle to address shortage and maldistribution of health professionals, affecting equity in service delivery. The government endeavors to generate adequate supply of health workforce through scholarship and training programs which have been further expanded with the enactment of the Universal Health Care (UHC) Act. This article aimed to give a background for discussion on the application of return service agreement (RSA) provisions in the light of attaining universal health care. Methods: A modified systematic review of literature was conducted guided by the key issues determined by the Department of Health with focus on the extent of scholarship grants and on number of recipients. Results: The Philippine government enacted policy reforms through implementing RSA in response to the progressive decline of the net flow of health professionals. However, the criticisms lie in that RSA is not a long-term solution. With the RSA provisions in the UHC Law, metrics on determining the under-produced and maldistributed professional cadre must be created. These should be responsive in addressing facility-level and health system-level gaps. Conclusion and Recommendation Paucity of current local literature impedes attaining a conclusive body of evidence, therefore, further research is needed. Operationalization of RSA should not be viewed as a singular means to solve the health workforce gaps, but as part of holistic assessment, taking into consideration epidemiological, geographical, political, and social determinants. Stakeholders must ingress in collaborative intersectoral policy actions to warrant bottom-up support. Activities related to mapping, monitoring, and incentivizing medical and health-related professionals must be established to support a system conducive for workforce retention.
Medically Underserved Area ; Health Workforce ; Health Services

u-Health based on ubiquitous information and communication network is being considered as an alternative to the mainstream face-to-face healthcare services in addition to its supportive functions. Traditional healthcare system has inherent problems such as limited accessibility and inadequate fulfillment of service needs to the underserved populations. Proponents of u-Health suggest that it will provide solutions to those problems. There have been many trials and pilot projects for telemedicine since 1988 in Korea, and the system is now called "u-Health". After legislation of clause regarding telehealth in the Korean medical law in 2002, local governments have made several attempts to utilize u-Health system to the patients with chronic disease living in rural under-served area. Recently, Korean government has implemented u-Health trial projects about tehemedicine, monitoring chronic disease, and providing homecare in the three underserved rural and many-islands area. Patients' perceived level of satisfaction, preference, attitude, and usability of u-Health was significantly high. Patient's compliance to u-Health has improved over time. A strategic approach based on the innovative and proactive mindset to the u-Health is strongly needed. At the time of u-Health implementation in the medically underserved area, utilization of both u-Health center and mobile clinic is recommended to achieve operational efficiency, and ensure high quality of service. Although u-Health is effective and supportive method to the mainstream face-to-face healthcare, we should be cautious, since u-Health model needs more development and more rigorous experiments.
Chronic Disease ; Compliance ; Delivery of Health Care ; Dietary Sucrose ; Humans ; Jurisprudence ; Korea ; Medically Underserved Area ; Pilot Projects ; Telemedicine ; Vulnerable Populations

PURPOSE: The purpose of this study was to explore how older adults kept their health good at a doctorless farm village. METHOD: Data was collected through in-depth interviews with 32 participants who were over 65 years old and analyzed in terms of Strauss and Corbin`s (1990) grounded theory methodology. RESULT: The Core Category of health care of older adults was identified as "enduring physical changes by themselves". The process of this could be divided into 4 stages : the stage of bearing, the stage of managing daily living activities, the stage of passively collecting information and the stage of minimally utilizing health care services. Older adults accepted the aging process positively but health sources limitation passively, so they managed daily living activities and used natural food for health. In addition, they collected information related to health care and used health care services minimally. CONCLUSION: We found that participants managed their health passively because of negative attitudes toward active health behaviors of older adults by themselves and the difficulty of access to health care services. Therefore, various community health services for older adults need to be developed to empower older adults in the community.
Aged ; Aged, 80 and over ; Female ; *Health Services for the Aged ; *Health Status ; Humans ; Korea ; Male ; Medically Underserved Area ; *Rural Health Services ; Rural Population ; *Self Care

In 2011, the government of South Korea established a support program for obstetric care for underserved geographical areas to address the serious problem of the low birth rate. The birth rate of some underserved areas has since been increasing, and several indexes of mother and child health have since improved. However, various problems have also been noted in the evaluation of the policy for this support program. The birth rate of some rural areas remains low, and the inadequacy of professional health care providers has not been resolved. The medical fee for delivery should be rationalized, and countermeasures for medical litigation should be established. Furthermore, better communication between local residents and healthcare providers are necessary to improve maternal and child health. For effective long-term provision of obstetric care through this support program for underserved areas, new outcome and evaluation standards are necessary. Critical requirements for launching an initial support program and outcomes including the birth rate and indices of maternal and child health should be itemized and assessed. Support for health care providers requires expansion including support personnel, the establishment of a transfer system, and measures to address legal problems. A multifaceted approach including regular maternal education and an information network system for local residents is necessary. Future support programs should include total care for maternal and child health, so cooperation of the government offices and health care centers is essential. At the same time, new standards of evaluation of obstetric care support programs for underserved areas need to be established for appropriate evaluation of comprehensive family health.
Birth Rate ; Child Health ; Delivery of Health Care ; Education ; Evaluation Studies as Topic ; Family Health ; Fees, Medical ; Health Personnel ; Humans ; Information Services ; Jurisprudence ; Korea* ; Medically Underserved Area ; Mothers

BACKGROUND: As of 2011, among 250 administrative districts in Korea, 54 districts did not have obstetrics and gynecology clinics or hospitals providing prenatal care and delivery services. The Korean government designated 38 regions among 54 districts as “Obstetric Care Underserved Areas (OCUA).” However, little is known there are any differences in pregnancy, prenatal care, and outcomes of women dwelling in OCUA compared to women in other areas. The purposes of this study were to compare the pregnancy related indicators (PRIs) and adequacy of prenatal care between OCUA region and non-OCUA region. METHODS: Using National Health Insurance database in Korea from January 1, 2012 to December 31, 2014, we constructed the whole dataset of women who terminated pregnancy including delivery and abortion. We assessed incidence rate of 17 PRIs and adequacy of prenatal care. All indicators were compared between OCUA group and non-OCUA group. RESULTS: The women dwelling in OCUA regions were more likely to get abortion (4.6% in OCUA vs. 3.6% in non-OCUA) and receive inadequate prenatal care (7.2% vs. 4.4%). Regarding abortion rate, there were significant regional differences in abortion rate. The highest abortion rate was 10.3% and the lowest region was 1.2%. Among 38 OCUA regions, 29 regions' abortion rates were higher than the national average of abortion rate (3.56%) and there were 10 regions in which abortion rates were higher than 7.0%. In addition, some PRIs such as acute pyelonephritis and transfusion in obstetric hemorrhage were more worse in OCUA regions compared to non-OCUA regions. CONCLUSION: PRIs are different according to the regions where women are living. The Korean government should make an effort reducing these gaps of obstetric cares between OCUA and non-OCUA.
Abortion, Induced ; Dataset ; Female ; Gynecology ; Hemorrhage ; Humans ; Incidence ; Korea ; Medically Underserved Area ; National Health Programs ; Obstetrics ; Pregnancy ; Pregnant Women* ; Prenatal Care* ; Pyelonephritis

PURPOSE: This study aimed to understand why mothers do not utilize the prenatal care and delivery services at their local hospital supported by the government program, the Supporting Program for Obstetric Care Underserved Area (SPOU). METHODS: We conducted a focus group interview by recruiting four mothers who delivered in the hospital in their community (a rural underserved obstetric care area) and another four mothers who delivered in the hospital outside of the community. RESULTS: From the finding, the mothers were not satisfied with the quality of services that the community hospital provided, in terms of professionalism of the obstetric care team, and the outdated medical device and facilities. Also, the mothers believed that the hospital in the metropolitan city is better for their health as well as that of their babies. The mothers who delivered in the outside community hospital considered geographical closeness less than they did the quality of obstetric care. The mothers who delivered in the community hospital gave the reason why they chose the hospital, which was convenience and emergency preparedness due to its geographical closeness. However, they were not satisfied with the quality of services provided by the community hospital like the other mothers who delivered in the hospital outside of the community. CONCLUSIONS: Therefore, in order to successfully deliver the SPOU program, the Korean government should make an effort in increasing the quality of maternity service provided in the community hospital and improving the physical factors of a community hospital such as outdated medical equipment and facilities.
Delivery, Obstetric/statistics & numerical data ; Emergency Treatment ; Female ; Focus Groups ; Health Knowledge, Attitudes, Practice ; Hospitals, Community/*utilization ; Humans ; *Medically Underserved Area ; Mothers/psychology ; Patient Acceptance of Health Care/*psychology/statistics & numerical data ; Patient Satisfaction ; Pregnant Women/psychology ; Prenatal Care/*utilization ; Qualitative Research ; Quality Improvement ; Quality of Health Care ; Republic of Korea ; Trust

Despite low childbirth rate in Korea, the number of women with high-risk pregnancies is steadily increasing, mostly due to increased maternal age, multiple pregnancies, and obesity. In fact, one out of five Korean women is above 35 years old at childbirth. It is well known that high risk pregnancy is closely related with increased maternal mortality, either by direct or indirect causes. Despite such problems, however, Korea's health care infrastructure for childbirth has deteriorated, leaving approximately 20% of the geographic area of the country medically underserved with regard to optimal maternity care. Such a collapse has been caused by the decrease in the number of maternity hospitals and their financial difficulties due to medical fee reimbursement for childbirth being too low. The problem is aggravated by a lack of obstetricians who can provide skilled attendance at childbirth. In addition, extensive legal pressure has dissuaded talented medical students from pursuing obstetrics and gynecology, thereby resulting in aging and severe gender imbalance in such professions. The direct consequence of the collapse in infrastructure for childbirth is an increased maternal mortality ratio, especially in underserved areas. Moreover, increased maternal death caused by postpartum bleeding reflects an obvious sign of danger in the maternal health care system. Furthermore, the number of tertiary hospitals that can provide optimal care to high risk pregnant women has decreased to two-thirds of what it once was, and the training of competent obstetricians for the mothers of the future continues to be a difficulty.
Aging ; Aptitude ; Delivery of Health Care ; Fees, Medical ; Female ; Gynecology ; Hemorrhage ; Hospitals, Maternity ; Humans ; Korea ; Maternal Age ; Maternal Death ; Maternal Health ; Maternal Mortality ; Medically Underserved Area ; Mothers ; Obesity ; Obstetrics ; Obstetrics and Gynecology Department, Hospital ; Parturition* ; Postpartum Period ; Pregnancy ; Pregnancy, High-Risk ; Pregnancy, Multiple ; Pregnant Women ; Students, Medical ; Tertiary Care Centers

OBJECTIVETo investigate the differences in level of common knowledge toward common psychiatric disorders and means of therapy in general population, resulting from different education levels and living areas.

METHODSAll 4,614 persons over 15 years of age recruited from general population in Zhejiang Province via stratified randomly sampling, were classified by education levels as illiteracy, primary school level, high school level, and college level. Each group was thus divided into two categories according to the person's living areas, ie urban and rural area. The level of common knowledge about psychosis and means of therapy were measured by a questionnaire administered to all subjects.

RESULTSThe rate of knowledge of neurasthenic was the highest, reaching to 71.1%, then of knowledge of schizophrenia and depression, was 47.9% and 39.3% respectively, and the rate of knowledge of alcohol dependence, mania and obsessive-compulsive disorder was lower than 20%. The rate of knowledge of the 6 common psychiatric disorders was higher in people from urban area, than from rural areas. The rate of knowledge of common psychiatric disorders was increased correspondingly to the increase of the education level among the people residing at the same living area. The main means of therapy the people selected was western medicine and psychology, reaching at 24.0% and 34.8% respectively. There were significant differences among the people with different education levels but from the same living areas, and the people with lower education levels were likely to choose the therapy of western medicine, on the other hand, the people with higher education levels were tending to choose the therapy of psychology.

CONCLUSIONThe popularization of the knowledge and the education about mental health should be reinforced, as to improving the knowledge about mental health, choosing a correct means of therapy to the common psychiatric disorders and promoting the mental health status of the population.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; China ; epidemiology ; Diagnostic and Statistical Manual of Mental Disorders ; Educational Status ; Female ; Humans ; Knowledge ; Male ; Medically Underserved Area ; Mental Disorders ; epidemiology ; psychology ; Middle Aged ; Patient Acceptance of Health Care ; psychology ; statistics & numerical data ; Rural Population ; statistics & numerical data ; Surveys and Questionnaires ; Urban Population ; statistics & numerical data ; Young Adult