<p style="text-align: justify;">BACKGROUND: PhilHealth, a government owned and controlled corporation which runs the country's social health insurance program, has given conflicting impressions of its financial position in various public forums. This study aims to describe the financial position of PhilHealth up to 2010 based on COA audit reports.p> <p style="text-align: justify;">METHODS: Financial statements from Commision on Audit (COA) Annual Audit Reports on PhilHealth from the years 1999-2010 were reviewed to describe PhilHealth's financial position.p> <p style="text-align: justify;">RESULTS: Up to 2010, based on COA audited reports, PhilHealth was financially solvent. Its net financial worth has steadily increased to P106.9B in 2010. PhilHealth's sources of revenues were mainly from premiums (82.7%) and interest income (17.0%). From 2007-2010, 88.5% of PhilHealth's premiums came from paying members. Premiums of the informal sector made up only 4.7% of toal premiums. Expenses were made up of benefit payments and administrative expenditures. PhilHealth exceeded its allowed administrative expenses for the years 2004, 2008 and 2009. PhilHealth's stated reserve fund has steadily increased and had rearched P90.7B in 2010. Several questions, outside of the scope of an analysis of the COA audit reports and involving reimbursements and adminstrative expenses need further investigation.p> <p style="text-align: justify;">CONCLUSIONS AND RECOMMENDATIONS: At its level of purchasing up to 2010, PhilHealth was indeed sustainable. But as one of the three pillars of Kalusugan Pangkalahatan (KP), PhilHealth has to dramatically increase its share in the country's Total Health Expenditure. PhilHealth's financial position has to be continuously monitored as KP is being implemented.p>
Health Expenditures ; Financial Statements ; Informal Sector ; Insurance, Health ; Social Security ; Income ; Solvents

<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

Objective. The present study aims to correlate the LGU list of PhilHealth Sponsored Members in a municipality of Batangas with the list of poor residents as identified by the Participatory Action Research (PAR) methodology. Method. Interview of key informants documented the processes utilized by the LGU in determining PhilHealth beneficiaries for the Sponsored Program and the Participatory Action Research (PAR) survey in the classification of households into poor, middle and rich in four barangays of the municipality. The list of LGU Sponsored members was then cross matched with the PAR household classification. Results. The comparison of the LGU list of Sponsored members and the household classification by the PAR survey showed a wide discrepancy: (1) 464 "Not Found" Sponsored households or 70% of the LGU's Sponsored list; (2) inclusion of the non-poor: 140 middle class families as classified by the PAR survey or 21.1% of the LGU's Sponsored list; and (3) exclusion of 413 or 87.5% of true poor families identified by the PAR Survey. Only 59 families or 8.9% of the LGU Sponsored list were classified as poor families by PAR. Conclusion. PAR offers communities, LGUs and the National Health Insurance Program a tool to validate the coverage of the Sponsored program. LGUs and the PhilHealth should consider such tool or similar tools to validate their identification, selection and enrollment of the poor, which is extremely vital in achieving universal coverage. Given the right tool, communities are in the best position to identify the poor for the Sponsored program. By way of collaboration with the underprivileged themselves, the academe has a role in assisting communities in acquiring collective awareness of their own situation and developing capacity for improving their lives. The academe also has a role in assisting LGUs in improving their health systems and national health programs in validating and improving their implementation. Further studies should be done to investigate the following: the identity of the "not found" SP members; the utilization of PhilHealth benefits by the poor; and the prospect of utilizing the PAR method by other non-academic institutions in monitoring the progress of community programs.
Human ; Male ; Female ; PUBLIC-PRIVATE SECTOR PARTNERSHIPS ; HEALTH SERVICES ; INSURANCE, HEALTH ; HEALTH CARE ECONOMICS AND ORGANIZATIONS ; ECONOMICS ; FINANCING, ORGANIZED ; INSURANCE

Background: Health inequities in the Philippines are driven by health workforce maldistribution and health system fragmentation. These can be addressed by strengthening primary care through central social health insurance (PhilHealth) coverage. However, high reported PhilHealth population coverage and health provider accreditation have not necessarily increased health benefit utilization or financial risk protection. Objective: This study aims to examine the impact of an enhanced, comprehensive primary care benefits package at a university-based health facility. This paper reports baseline utilization of health services and health benefits, and out-of-pocket health spending in two socioeconomic strata of the catchment population, for outpatient and inpatient services. Methods: A questionnaire-guided survey was done among randomly selected faculty (higher income group) and non-faculty (lower income group) employees to determine the frequencies and costs of using outpatient and inpatient health services, and amounts paid out-of-pocket. Results: Annually, both groups had approximately 1 consultation/patient and about 15 hospitalizations per 100 families annually. For hospitalizations, non-faculty inpatients utilized health insurance more frequently than faculty inpatients (75.7% vs. 66.7%), but paid higher out-of-pocket proportions (73.3% or Php 92,479/hospitalization vs. 57.4% or Php 16,273/hospitalization). For outpatient care, health benefit utilization rates were higher among non-faculty (12.4% vs 2.1% of consultations) although low overall, with similar total (Php 2,319 vs Php 1,741) and out-of-pocket expenses (100%). Conclusion These findings confirm inequities in accessing outpatient and inpatient health services and utilizing health insurance benefits in the target population.
Primary Health Care ; Health Equity ; Insurance, Health

Background: The Philippine Primary Care Studies (PPCS) is a network of pilot studies that developed, implemented, and tested strategies to strengthen primary care in the country. These pilot studies were implemented in an urban, rural, and remote setting. The aim is to use the findings to guide the policies of the national health insurance program (PhilHealth), the main payor for individualized healthcare services in the country. Objective: The objective of this report is to compare baseline outpatient benefit utilization, hospitalization, and health spending, including out-of-pocket (OOP) expenses, in three health settings (urban, rural, and remote). These findings were used to contextualize strategies to strengthen primary care in these three settings. Methods: Cross-sectional surveys were carried out using an interviewer-assisted questionnaire on a random sample of families in the urban site, and a stratified random sample of households in the rural and remote sites. The questionnaire asked for out-patient and hospitalization utilization and spending, including the OOP expenses. Results: A total of 787 families/households were sampled across the three sites. For outpatient benefits, utilization was low in all sites. The remote site had the lowest utilization at only 15%. Unexpectedly, the average annual OOP expenses for outpatient consults in the remote site was PhP 571.92/per capita. This is 40% higher than expenses shouldered by families in the rural area, but similar with the urban site. For hospital benefits, utilization was lowest in the remote site (55.7%) compared to 75.0% and 78.1% for the urban and rural sites, respectively. OOP expenses per year were highest in the remote site at PhP 2204.44 per capita, probably because of delay in access to healthcare and consequently more severe conditions. Surprisingly, annual expenses per year for families in the rural sites (PhP 672.03 per capita) were less than half of what families in the urban sites spent (PhP 1783.38 per capita). Conclusions Compared to families in the urban site and households in the rural sites, households in remote areas have higher disease rates and consequently, increased need for outpatient and inpatient health services. When they do get sick, access to care is more difficult. This leads to lower rates of benefit utilization and higher out-of-pocket expenses. Thus, provision of “equal” benefits can inadvertently lead to “inequitable” healthcare, pushing disadvantaged populations into a greater disadvantage. These results imply that health benefits need to be allocated according to need. Families in poorer and more remote areas may require greater subsidies.

BACKGROUND<p style="text-align: justify;" data-mce-style="text-align: justify;">The Philippine Primary Care Studies (PPCS) is a network of pilot studies that developed, implemented, and tested strategies to strengthen primary care in the country. These pilot studies were implemented in an urban, rural, and remote setting. The aim is to use the findings to guide the policies of the national health insurance program (PhilHealth), the main payor for individualized healthcare services in the country.p>OBJECTIVE<p style="text-align: justify;" data-mce-style="text-align: justify;">The objective of this report is to compare baseline outpatient benefit utilization, hospitalization, and health spending, including out-of-pocket (OOP) expenses, in three health settings (urban, rural, and remote). These findings were used to contextualize strategies to strengthen primary care in these three settings.p>METHODS<p style="text-align: justify;" data-mce-style="text-align: justify;">Cross-sectional surveys were carried out using an interviewer-assisted questionnaire on a random sample of families in the urban site, and a stratified random sample of households in the rural and remote sites. The questionnaire asked for out-patient and hospitalization utilization and spending, including the OOP expenses.p>RESULTS<p style="text-align: justify;" data-mce-style="text-align: justify;">A total of 787 families/households were sampled across the three sites. For outpatient benefits, utilization was low in all sites. The remote site had the lowest utilization at only 15%. Unexpectedly, the average annual OOP expenses for outpatient consults in the remote site was PhP 571.92/per capita. This is 40% higher than expenses shouldered by families in the rural area, but similar with the urban site. For hospital benefits, utilization was lowest in the remote site (55.7%) compared to 75.0% and 78.1% for the urban and rural sites, respectively. OOP expenses per year were highest in the remote site at PhP 2204.44 per capita, probably because of delay in access to healthcare and consequently more severe conditions. Surprisingly, annual expenses per year for families in the rural sites (PhP 672.03 per capita) were less than half of what families in the urban sites spent (PhP 1783.38 per capita).p>CONCLUSIONS<p style="text-align: justify;" data-mce-style="text-align: justify;">Compared to families in the urban site and households in the rural sites, households in remote areas have higher disease rates and consequently, increased need for outpatient and inpatient health services. When they do get sick, access to care is more difficult. This leads to lower rates of benefit utilization and higher out-of-pocket expenses. Thus, provision of “equal” benefits can inadvertently lead to “inequitable” healthcare, pushing disadvantaged populations into a greater disadvantage. These results imply that health benefits need to be allocated according to need. Families in poorer and more remote areas may require greater subsidies.p>
Primary Health Care ; Insurance, Health

The National Academy of Science and Technology (NAST), in cooperation with the Philippine Primary Care Studies (PPCS), organized the Stakeholders’ Meeting on Training Objectives for Primary Care in the Philippines on February 1, 2018, at Hotel Jen, Pasay City. The stakeholder’s meeting arrived at a consensus on the objectives of primary care workshops, training the existing cadre of doctors, nurses, midwives, and BHWs in the country. Competencies built upon these training objectives will strengthen the capacity of health care workers to render patient-centered primary care services. The expected output was not intended to replace the objectives of existing professional training curricula. Instead, the consensus obtained through this meeting works to establish the framework from which future primary care training workshops can be built upon.
Primary Health Care ; Health Care Reform ; Education ; Health Equity ; Congress

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).
Healthcare Financing ; Costs and Cost Analysis ; Primary Health Care

Methods: Data on governance issues were obtained from participant observation and regular meetings facilitated over one year. Conducted across urban, rural, and remote settings, the present study outlines experience-near insights throughout a hierarchy of system implementers—from those in positions of authority to frontline workers. These insights were thematically analyzed and organized following the Health System Dynamics Framework. Results: This study identified six governance challenges: 1) establishing a health information system; 2) engaging leaders, healthcare staff, and communities; 3) assuring efficient financing; 4) assuring health workforce sufficiency; 5) addressing legal challenges; and 6) planning evaluation and monitoring. To address these challenges, this study forwards systemic solutions to advance effective governance and improve healthcare performance. Conclusion A renewed approach to strengthening primary care systems is fundamental to achieving universal healthcare. This entails good governance that develops strategies, equips people with tools for proper implementation, and provides data for evidence-based policies. The experiences outlined in the present study envisions guiding policymakers toward improving health outcomes in a devolved setting.
primary care ; universal healthcare ; health systems ; interventions

Background and Objective: Primary care providers are key players in providing quality care to patients and advancing Universal Health Care (UHC). However, effective and quality healthcare delivery may be affected by inadequate knowledge and failure to adhere to evidence-based guidelines among providers. The Philippine Primary Care Studies (PPCS) is a five-year program that pilot tested interventions aimed at strengthening the primary care system in the country. Evidence-based training modules for healthcare providers were administered in Sorsogon and Bataan from the years 2018 to 2021. Module topics were selected based on common health conditions encountered by providers in rural and remote settings. This program aimed to evaluate the effectiveness of training in increasing provider knowledge. Methods: A series of training workshops were conducted among 184 remote- and 210 rural-based primary care providers [nurses, midwives, barangay or village health workers (BHWs)]. They covered four modules: essential intrapartum and newborn care (EINC), integrated management of childhood illness (IMCI), non-communicable diseases (NCD), and geriatrics. A decision support system (UpToDate) was provided as a supplementary resource for all participants. We administered pre-tests and post-tests consisting of multiple-choice questions on common health conditions. Data was analyzed using paired one-tailed t-test, with an alpha of 0.05. Results: The knowledge of nurses, midwives, and BHWs improved after the training workshops were conducted. The largest increase from pre-test to post-test scores were observed among the midwives, with a mean difference (MD) of 32.9% (95% CI 23.9 to 41.9) on the EINC module, MD of 25.0% (95% CI 16.6 to 33.4) in the geriatrics module, and MD of 13.5% (95% CI 6.9 to 20.1) in the NCDs module. The nurses had the greatest improvement in the IMCI module (MD 10.8%, 95% CI 2.5 to 19.1). The knowledge of BHWs improved in all participated modules, with greatest improvement in the NCD module (MD 9.0%, 95% CI 5.77 to 12.14). Conclusions Primary care workshops, even if conducted as single-sessions and on a short-term basis, are effective in improving short-term knowledge of providers. However, this may not translate to long-term knowledge and application in practice. Furthermore, comparisons across provider categories cannot be made as participant composition for each training workshop varied. Ultimately, this study shows enhancing provider knowledge and competence in primary care will therefore require regular and diverse learning interventions and access to clinical decision support tools.
Capacity Building ; Health Workforce ; Philippines ; Primary Health Care