OBJECTIVE

This study analyzed the factors influencing the implementation of the disability benefit package for children with developmental disabilities (CDDs) in the Philippines.

Data collection was done through document review of policy documents and focused group discussions (FGDs). Guided by Walt and Gilson’s policy triangle framework, data were analyzed through content analysis.

Twenty-two (22) policy documents were reviewed and a total of 16 participants joined the FGDs. Facilitators and barriers were identified and categorized through the policy elements: 1) context is anchored by presence of laws and policies but is hindered by issues on politics, governance, and labor force; 2) policy actors are hopeful in the continuous implementation of the policy but there is a lack of participation from all potential policy actors and limitations with human resources; 3) content is sound and comprehensive but there are costing issues and compliance concerns with requirements; and 4) processes emphasize quality assurance and promising initial dissemination efforts but the lack of stakeholder engagement activities and the tediousness of requirements discourage potential service providers.

While the launch of the disability benefit package for CDDs in the Philippines seemed promising, the policy remains underutilized as the identified barriers outweigh the facilitators. Specific recommendations for the improvement and implementation of the benefit package were outlined and framed based on the policy triangle framework.

OBJECTIVE

This study analyzed the factors influencing the implementation of the disability benefit package for children with developmental disabilities (CDDs) in the Philippines.

Data collection was done through document review of policy documents and focused group discussions (FGDs). Guided by Walt and Gilson’s policy triangle framework, data were analyzed through content analysis.

Twenty-two (22) policy documents were reviewed and a total of 16 participants joined the FGDs. Facilitators and barriers were identified and categorized through the policy elements: 1) context is anchored by presence of laws and policies but is hindered by issues on politics, governance, and labor force; 2) policy actors are hopeful in the continuous implementation of the policy but there is a lack of participation from all potential policy actors and limitations with human resources; 3) content is sound and comprehensive but there are costing issues and compliance concerns with requirements; and 4) processes emphasize quality assurance and promising initial dissemination efforts but the lack of stakeholder engagement activities and the tediousness of requirements discourage potential service providers.

While the launch of the disability benefit package for CDDs in the Philippines seemed promising, the policy remains underutilized as the identified barriers outweigh the facilitators. Specific recommendations for the improvement and implementation of the benefit package were outlined and framed based on the policy triangle framework.

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.

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.

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.

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).

BACKGROUND

Family and Community Medicine is a medical specialty that plays a crucial role in the healthcare system and will be in the best capacity to provide primary care services, coordinate referrals to specialists when needed, and promote continuity of care across different healthcare settings in the implementation of the Universal Health Care Law. These are policy recommendations on how family and community medicine can play a significant role in the successful implementation of the UHC.

Recommendation #1. The undergraduate curriculum in Family and Community Medicine must be competency based.

Recommendation #2. The competency outcome of Family and Community Medicine undergraduate curriculum must be aligned with the need of the Philippine health system in the context of Universal Health Care reform.

Recommendation #3. The process of delivery of Family and Community Medicine undergraduate curriculum must adopt to new technology and teaching innovation.

Recommendation #4. Family and Community Medicine must develop strategies to make it as career choice.

Recommendation #5. Family and Community Medicine must develop and implement an effective and sustainable faculty development program.

Recommendation #6. Family and Community Medicine must be socially accountable to the community it serves.

Recommendation #7. Family and Community Medicine must be one of the major core competencies of a licensed physician ready to practice as primary care provider in the UHC.

Recommendation #8. Early placement for Family and Community Medicine practice must be available for newly licensed physicians.

Recommendation #9. Family and Community Medicine practitioners must be provided with continuing professional education and training to provide quality patient care.

Recommendation #10. Family and Community Medicine postgraduate education and training must adopt to new technology and training innovation.

Recommendation #11. Family and Community Medicine postgraduate training should cover urban and rural community health service.

Recommendation #12. Family and Community Medicine continuing professional education and training programs must meet the prescribed standards.

Recommendation #13. Regulation of Family and Community Medicine practice must be a public-private partnership.

Objective: To develop a preliminary subjective evaluation scale for assessing the built environments of China's Hygienic City Initiative and to evaluate its reliability and validity. Methods: The initial items of the scale were determined based on a review of policy documents and consultations with experts. The final items of the scale were confirmed through individual interviews with residents combined with the discretetrend method, critical ratio method, correlation coefficient method, and factor analysis method. Then, the dimensions of the scale were determined using exploratory factor analysis (EFA). The Cronbach's Results: A scale containing five dimensions with 22 items was established, including urban lifestyle, governance, basic functions, environmental sanitation, and amenities. The Cronbach's Conclusion The preliminarily subjective evaluation scale for assessing the built environments of China's Hygienic City Initiative demonstrates a high level of reliability and validity. Additional empirical studies should be carried out to further verify the value of the scale in terms of practical application.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Built Environment/psychology* ; China ; Factor Analysis, Statistical ; Female ; Health Policy ; Humans ; Hygiene ; Male ; Middle Aged ; Perception ; Personal Satisfaction ; Reproducibility of Results ; Surveys and Questionnaires ; Urban Health ; Young Adult

BACKGROUND: China has the largest elderly population in the world; little attention has been paid to the mental health of elderly in areas of extreme poverty. This is the first study to investigate the mental health of the rural elderly in poverty state counties in Chongqing and was part of the Chongqing 2018 health literacy promotion project. METHODS: In 2019, a cross-sectional study was conducted to investigate the mental health status of the rural elderly in fourteen poverty state counties of Chongqing, in which a total of 1400 elderly aged ≥ 65 years were interviewed, where mental health status was measured by the ten-item Kessler10 (K10) scale. Ordered multivariate logistic regression was performed to evaluate the influencing factors related to mental health of the elderly in these areas. RESULTS: The average score of K10 in 14 poverty state counties was 17.40 ± 6.31, 47.6% was labeled as good, 30.2% was moderate, 17.0% was poor, and lastly 5.1% was bad, and the mental health status of the elderly in the northeastern wing of Chongqing was better than the one in the southeastern wing of Chongqing. A worse self-rated health was the risk factor for mental health both in the northeastern and southeastern wings of Chongqing (all P < 0.001). Lower education level (OR (95% CI) = 1.45 (1.12-1.87), P = 0.004) was a risk factor in the northeastern wing, whereas older age (OR (95% CI) = 1.33 (1.13-1.56), P = 0.001) was a risk factors in the southeastern wing. CONCLUSIONS The results showed that mental health of the elderly in poverty state counties was poor, especially in the southeastern wing of Chongqing. Particular attention needs to be paid to the males who were less educated, older, and single; female with lower annual per capital income; and especially the elderly with poor self-rated health.
Aged ; Aged, 80 and over ; China ; Cross-Sectional Studies ; Female ; Health Policy ; Humans ; Logistic Models ; Male ; Mental Health ; statistics & numerical data ; Multivariate Analysis ; Rural Population ; statistics & numerical data ; Socioeconomic Factors

Background: The Universal Health Care (UHC) Act is a landmark legislation that seeks to improve provision of comprehensive health services through the integration of local health systems. The Department of Health (DOH) conducted a series of roundtable discussions to gather stakeholders' inputs and concerns to refine the initial draft of the Implementing Rules and Regulations (IRR) of UHC. Methods: On April 4, 2019, the Department of Health led a roundtable discussion on the Local Health Systems sections of the UHC IRR in collaboration with University of the Philippines Manila. A total of 65 stakeholders from different sectors participated in a semi-structured roundtable event. The proceedings were audio recorded and transcribed. A thematic analysis was done using NVivo 12 software to document gaps and gray areas identified by the participants. Results: Concerns of the participants revolved around the following: role of the private sector in local health systems; the integration of different municipal and other component health systems into a province-wide health system; organizational design of the health systems; pooling and utilization of the Special Health Fund (SHF). Gaps andgray areas were concentrated on the transfer of personnel and other health resources to the province-wide system, the composition of the Provincial Health Board, and the utilization and management of the SHF. Conclusion The roundtable event acquired various perspectives from stakeholders that could help the DOH identify priority action points that could be resolved at the agency level. The identified themes from the study analysis could be of value to decision makers to clarify issues, address policy gaps, and to prioritize future research directions.
Universal Health Care ; Policy Making ; Medical Assistance ; Government Programs ; Health Policy ;

PURPOSE: This study aimed to examine the process from occurrence of a hospital nurse's suicide to workers' compensation approval, responses of the parties involved, issues debated during approval deliberations, and significant policy changes resulting from the incident.METHODS: We conducted in-depth interviews with involved parties and collected various documents, including newspaper articles, forum proceedings, and the agency report on determination of workers' compensation. Content analysis was performed on the collected data.RESULTS: A Joint Task Force continuously reported its progress and findings through mass media such as newspaper, radio, and TV. These activities exerted pressure on a government agency to conduct an occupational disease review and significantly impacted the workers' compensation approval. The agency recognized associations between the hospital's inadequate nurse training and the suicide but did not confirm the excessive overtime and workplace harassment experienced by the nurse as causes of the suicide. This case's media coverage and impact resulted in a law prohibiting workplace harassment and a hospital system dedicating at least one nurse to training activities.CONCLUSION: This incident had a significant social impact as the first case of workers' compensation approval for a hospital nurse's suicide. However, the case produced no structural changes in nurses' working conditions such as heavy workloads.
Advisory Committees ; Government Agencies ; Joints ; Jurisprudence ; Mass Media ; Occupational Diseases ; Occupational Health ; Social Change ; Suicide ; Teaching ; Workers' Compensation

INTRODUCTION: To prevent and manage the societal and economic burden of occupational diseases (ODs), countries should develop strong prevention policies, health surveillance and registry systems. This study aims to contribute to the improvement of OD surveillance at national level as well as to identify priority actions in Turkey.METHODS: The history and current status of occupational health studies were considered from the perspective of OD surveillance. Interpretative research was done through literature review on occupational health at national, regional and international level. Analyses were focused on countries’ experiences in policy development and practice, roles and responsibilities of institutions, multidisciplinary and intersectoral collaboration. OD surveillance models of Turkey, Belgium and the Netherlands were examined through exchange visits. Face-to-face interviews were conducted to explore the peculiarities of legislative and institutional structures, the best and worst practices, and approach principles.RESULTS: Some countries are more focused on exploring OD trends through effective and cost-efficient researches, with particular attention to new and emerging ODs. Other countries try to reach every single case of OD for compensation and rehabilitation. Each practice has advantages and shortcomings, but they are not mutually exclusive, and thus an effective combination is possible.CONCLUSION: Effective surveillance and registry approaches play a key role in the prevention of ODs. A well-designed system enables monitoring and assessment of OD prevalence and trends, and adoption of preventive measures while improving the effectiveness of redressing and compensation. A robust surveillance does not only provide protection of workers’ health but also advances prevention of economic losses.
Belgium ; Compensation and Redress ; Cooperative Behavior ; Health Policy ; Netherlands ; Occupational Diseases ; Occupational Health ; Policy Making ; Prevalence ; Rehabilitation ; Turkey

PURPOSE: A task force appointed by the Korean Society of Acute Care Surgery reviewed previously published guidelines on antibiotic use in patients with abdominal injuries and adapted guidelines for Korea. METHODS: Four guidelines were assessed using the Appraisal of Guidelines for Research and Evaluation II instrument. Five topics were considered: indication for antibiotics, time until first antibiotic use, antibiotic therapy duration, appropriate antibiotics, and antibiotic use in abdominal trauma patients with hemorrhagic shock. RESULTS: Patients requiring surgery need preoperative prophylactic antibiotics. Patients who do not require surgery do not need antibiotics. Antibiotics should be administered as soon as possible after injury. In the absence of hollow viscus injury, no additional antibiotic doses are needed. If hollow viscus injury is repaired within 12 hours, antibiotics should be continued for ≤ 24 hours. If hollow viscus injury is repaired after 12 hours, antibiotics should be limited to 7 days. Antibiotics can be administered for ≥7 days if hollow viscus injury is incompletely repaired or clinical signs persist. Broad-spectrum aerobic and anaerobic coverage antibiotics are preferred as the initial antibiotics. Second-generation cephalosporins are the recommended initial antibiotics. Third-generation cephalosporins are alternative choices. For hemorrhagic shock, the antibiotic dose may be increased twofold or threefold and repeated after transfusion of every 10 units of blood until there is no further blood loss. CONCLUSION: Although this guideline was drafted through adaptation of other guidelines, it may be meaningful in that it provides a consensus on the use of antibiotics in abdominal trauma patients in Korea.
Abdominal Injuries* ; Advisory Committees ; Anti-Bacterial Agents ; Antibiotic Prophylaxis ; Cephalosporins ; Consensus ; Humans ; Korea ; Shock, Hemorrhagic