Background: In order to financially sustain the participation of the private sector in the UHC, there is a need to find reasonable balance of accountability in the costing of health services. The costing must be based on actual resources used from the perspective of the private health service provider. Objective: The objective of this paper was to determine the cost of primary care services from the framework of the UHC reform in the private sector. Method: This is a multi-method approach to cost-identification in establishing and providing primary care health service in the UHC. The approaches used by the authors included review of published literature, laws and policies from DOH and other regulatory agencies. From this review, they develop the minimum facility requirement for basic primary care facility and primary care facility with ancillary services. They used the actual expenditures of existing primary care clinics, 2021 quotations from equipment and supplies companies, published construction rates and consensus approach to establish the cost. Based on 2021 value of Philippine Peso, they estimated the cost of constructing and operating a primary care facility. Results: The total estimated cost of building a primary health care facility based on the DOH licensing standard was estimated to be around PhP2,490,000. The cost of furniture and equipment as required in the DOH AO was PhP474,685. Thus, the total cost of the construction and equipment for a basic primary care facility setup is PhP2,964,685. We estimated the annual operating cost with the building estimated to depreciate in 20 years and the furniture and equipment in 5 years, the annualized cost for the building is PhP124,500 and for the furniture and equipment PhP94,937. The total annual salary of the staff based on government standards was PhP2,381,962. The maintenance, operating and overhead expenses (MOOE) which included water and electricity, repair and maintenance, waste disposal, supplies and other fees was PhP451,190. The total annual operating cost of a basic primary care facility is PhP3,052,590. This facility can provide basic services such as outpatient consultation and minor surgeries. Using the same approach for the basic facility, the total annual operating cost of a basic primary care facility with ancillary service is PhP11,023,670. This facility can provide outpatient consultation, minor surgeries and primary care services such as health education and preventive care plus the ancillary services like pharmacy, clinical laboratory and x-ray. For patients with diabetes, the total annual cost is PhP8,986. The significant cost driver is the clinical assessment and non-pharmacologic intervention. The researchers found the same cost pattern for the annual cost care of patients with hypertension but with a slightly higher annual total with PhP9,963. Their sensitivity analysis based on inflation, construction, equipment and operating expense may increase these cost estimates by 20% in the next 5 years. Conclusion Based on their findings, the current per capita support from PHIC Konsulta package is not adequate in the private sector both for wellness and care of patients with chronic condition. PHIC needs to consider adjusting per capita rates and consider case rate payment as it is currently doing for hospital care. Without this proposed adjustment, only those patients in the higher socioeconomic status will be capable of consulting the private sector. This scenario defeats the equity issue that is a primary concern in the UHC.
Universal Health Care

A good health system is supposed to improve the health of the population by providing effective health services equitably. Thus, the Universal Health Care (UHC) Act was designed to adopt a health care system that provides all Filipinos access to quality and cost-effective promotive, preventive, curative, rehabilitative and palliative health services without causing financial hardship especially the poor sector. There are four major elements in the UHC where family physicians can play a major role. The first is the population to be covered where there is now a shift of coverage from membership by premium payments to citizenship. The next is the health interventions to be included. This benefit package should be the one affordable to the whole society with priority to the worst-off sector. The next is the network of health professionals who will provide the health services. The network must be adequately distributed to provide service coverage for the whole population including the geographically isolated and disadvantaged areas. The last is the financing, where the delivery of health services must provide financial protection for the poor. To translate this into a realizable health sector reform agenda at the national and local level, there is a need for context-specific technical analyses and consultations from various sectors especially the private sector.
Universal Health Care ; Population

Universal Health Care

Background: Family physicians are at the forefront of the Universal Health Care (UHC) Act as primary care providers, and their attitudes and perceptions of the law can affect its implementation. These must be explored so that adequate organizational support can be provided to its members. Objective: This study describes the family physicians’ attitudes and perceptions towards UHC. It also determined if the attitudes and perceptions of family physicians are associated with the types of membership and their year of graduation from family medicine residency training. Methods: A cross-sectional study was conducted among active members of the Philippine Academy of Family Physicians (PAFP) during workshops held between January to February 2020. The PAFP UHC survey was employed to members who were purposively sampled during the workshops. The attitudes and perceptions of family physicians were summarized through frequencies and percentages, while the relationship of selected variables to physicians’ attitudes and perceptions were determined through a chi-square test. Results: A total of 195 family physicians from the three provinces and one city responded to the survey questionnaire. All (100%) participants reported a positive attitude toward their current practice, but this optimistic attitude slightly decreased to 85.4% regarding UHC. The perceptions of family physicians towards UHC practice are generally positive. Most have a realistic view on the comprehensiveness of service coverage (55.33%) and are agreeable to certification (84.62%) and accreditation by network (64.81%). Majority (82.17%) also have positive perception toward the future practice of family physicians. The year of graduation from training was found to be associated with their perception of the future practice of family physicians (p-value 0.048), and those with the older age group are more likely to report a negative perception. Conclusion PAFP members’ attitudes and perceptions towards UHC are mostly positive. Majority of respondents are positive about the inclusive PHIC membership, comprehensive service coverage, certification and accreditation, and the future of medical practice upon the implementation of UHC. The negative attitudes and perceptions of some members may be due to various factors related to the individual or to the processes of implementation and operationalization of the UHC law.
Universal Health Care ; Physicians, Family

Background: Primary care providers must evaluate their facilities and determine their capacity to comply with the requirements of the Universal Health Care (UHC) Act. Objective: This study describes the facility profiles of PAFP members in terms of the UHC requirements for licensing, certification and accreditation of health facilities. Methods: A cross-sectional study was conducted in four cities using the PAFP UHC Readiness survey. The study population included active members of PAFP who voluntarily answered the survey during workshops held between January to February 2020 Results: A total of 195 family physicians participated. Most of them work in hospital facilities (49.40%), while others have solo practice (27.38%), or are in group practice (20.24%). Most (69.61%) of the facilities have PHIC accreditation and SEC or DTI registration (74.47%). The availability of structures, equipment and pharmacies vary across the cities. Only half of the facilities have information technologies for clinical records (54.36%) or management (59.49%). Similarly, there are facilities which lack human resource personnel and only 54.10% of the facilities are networked with other facilities. The facilities’ revenues are mostly from fee-for-service (60%) and the cost of payments widely vary among the areas. Most of the facilities are managed financially by the owner and the income of the facility is the main source of capital for investment Conclusion Family physicians have existing structures and systems in their facilities but improvements on information technologies and networking are needed. They should also ensure affordability of care to patients while ensuring sustainability of facility operations
Universal Health Care ; Physicians, Family

: Background. Inequities in health care exist in the Philippines due to various modifiable and non-modifiable determinants. Through the years, different interventions were undertaken by the government and various stakeholders to address these inequities in primary care. However, inequities still continue to persist. The enactment of the Universal Health Care (UHC) Act aims to ensure that every Filipino will have equitable access to comprehensive and quality health care services by strengthening primary care. As a step towards UHC, the government endeavors to guarantee equity by prioritizing assistance and support to underserved areas in the country. This paper aims to review different interventions to promote equity in the underserved areas that could aid in needs assessment. Methods: A search through PUBMED and Google Scholar was conducted using the keywords, “inequity,” “primary care” and “Philippines.” The search yielded more than 10,000 articles which were further filtered to publication date, relevance to the topic, and credibility of source. A total of 58 full-text records were included in the review. Results and Discussion: In the Philippines, inequities in primary care exist in the context of health programs, facilities, human health resources, finances, and training. These were recognized by various stakeholders, from government and private sector, and nongovernment organizations, taking actions to address inequities, applying different strategies and approaches but with a shared goal of improving primary care. On another end, social accountability must also be instilled among Filipinos to address identified social and behavioral barriers in seeking primary care. With political commitment, improvement in primary care towards health equity can be achieved. Conclusion and Recommendation To address inequities in primary care, there is a need to ensure adequate human resources for health, facilities, supplies such as medications, vaccination, clean water, and sources of funds. Moreover, regular conduct of training on healthcare services and delivery are needed. These will capacitate health workers and government leaders with continuous advancement in knowledge and skills, to be effective providers of primary care. Institutionalizing advocacy in equity through policies in healthcare provision would help realize the aims of the Universal Health Care Act.
Philippines ; Universal Health Care ; Primary Health Care

Achievement of Universal Health Care (UHC) in the Philippines requires capable health workers who can navigate changes and lead in the local implementation of health system reforms. Public health nurses are in a strategic position to lead in UHC implementation as they constitute the largest cadre of health workers in the public health setting, and core concepts of UHC intersect with principles of public health nursing practice. This paper aims to describe the development and implementation of a leadership training program for public health nurses in the Philippines, in response to UHC. Document reviews of training reports and evaluations, including course site data analytics, and evaluation of the training program were done for the four cohorts of the course. The University of the Philippines Manila College of Nursing, with support from the Department of Health, responded to the increased demand of the Philippine health system for public health nurses with strong foundations and advanced skills by designing and offering a leadership development course specific to PHNs. From November 2019 to March 2022, a total of 183 participants from 17 regions completed the training. With the COVID-19 pandemic and dynamic changes in governance, the experiences of the project highlighted the need for flexibility in delivering the training program, updating module contents according to the latest developments, and improving course duration and evaluation. Barriers to course engagement and completion must be addressed for PHNs, their workplaces, clients, and the health system to benefit the most from the training.
Nurses, Public Health ; Universal Health Care ; Nursing

Background: The passage of the Universal Health Care (UHC) Act in the Philippines in early 2019 intensified the need to ensure equitable health investments by the government. Exploring the different criteria and indicators that are used to determine areas that are most in need of health services can help local and national health authorities determine priorities for health investments given finite resources. Methods: A systematic review of literature on determinants of health equity and other indicators was conducted as pre-work to generate discussion points to the roundtable discussion participated by all major key stakeholders. Shared insights and expertise were thematically analyzed to produce a policy paper with consensus policy recommendations. Results: Based on the review of the literature and the discussion, indicators (mainly physical inaccessibility and socioeconomic factors) for identifying Geographically Isolated and Disadvantaged Areas (GIDA) in DOH Administrative Order 185, s. 2004 is used to prioritize municipalities for health investments. Review of other policies and guidelines to determine the level of health needs and prioritizing investments yielded to four laddered domains: geographic, population characteristics (e.g., social and cultural determinants of access), health system (e.g., health service delivery), and health status. These domains may provide a more equitable set of metrics for health investment. The Local Investment Plan for Health (LIPH) is the current process used for health-related investments at the local level and may be revised to be more responsive to the requirements set by the UHC Act 2018. Hot spotting to concentrate health services by communities may be a more rapid approach to investment planning for health. Bed capacity as a specific metric in the UHC Act 2018 highlights the need for a review of the Hospital Licensure Act 2004. Conclusion and Recommendations To aid in determining priorities for health investments, a comprehensive integrated analysis of resources, determinants, and indicators should be done to determine the need and the gaps in the available resources. Innovative strategies can also be best implemented such as mathematical models or formulas. Lastly, current strategies in the development, monitoring, and evaluation of investment planning for health at different levels should be strengthened, expanded, and harmonized with other existing development plans.
Universal Health Care ; Health Equity ; Investments

Background: The Universal Health Care (UHC) Act seeks to delineate the roles of key agencies and stakeholders towards equity in access to quality and affordable health care. Under the pillar of health regulation, the Philippine Health Insurance Corporation is mandated to recognize third party accreditation mechanisms as a basis for granting incentives to health facilities that provide better service quality, efficiency, and equity. Methods: A systematic review of literature was conducted to generate a policy brief that outlined the strengths and weaknesses of the current accreditation system, and how to address arising fragmentation issues in implementation based on international and local evidence. To generate recommendations from a multi-stakeholder approach, a roundtable discussion enjoined by all major stakeholders of the policy issue was conducted by the University of the Philippines Manila Health Policy Development Hub in collaboration with the Department of Health. Thematic analysis of the RTD and the literature review were utilized in crafting the position statement with the general aim of producing consensus policy recommendations, as inputs in the Implementing Rules and Regulations of the Act. Results: Policy analysis using results of literature review and policy discussion was crafted, with thematically arranged recommendations in the domains of leadership and governance, financing and sustainability, standards development, program development, and continuing quality improvement that could help the national health system in determining third party accreditation mechanisms set forth by the UHC Act. Significant issues raised was the composition and requirements of the third party accreditor and the risks in transition. Conclusion and Recommendation With the PhilHealth Benchbook setting the standards and with the expressed commitment of stakeholders for third party accreditation, it is an opportune time for the UHC Act to institutionalize the accreditation mechanisms that will address existing challenges of PhilHealth accreditation. The literature review and discussion bring forth the proposed tool for the criteria in selecting third party accreditors.
Universal Health Care ; National Health Programs ; Accreditation

Accessing health care services can lead to a significant financial burden on patients, especially when an episode of illness necessitates out-of-pocket (OOP) expenditures.1 Apart from health improvement, an essential function of health care systems is to provide financial protection for individuals against the costs associated with illness.2 The establishment of the Philippine Health Insurance Corporation (PhilHealth) has emerged as a crucial step towards achieving the goal of universal health care for individuals in need of medical services.3 Since the passage of the Universal Health Care Act in 2019, all Filipinos have been automatically enrolled in PhilHealth for social health risk protection. In 2021, PhilHealth covered health care utilization claims amounting to over Php 88 billion.4 PhilHealth coverage is usually not sufficient to fund the entire hospital expense in a single episode of illness. Meanwhile, the creation of other government health care financing schemes helps alleviate the financial burden of patients. Through the enactment of the Republic Act (RA) 11463, also known as the Malasakit Centers Act, patients may now seek financial aid from a unified assistance hub to settle outstanding health care expenses not covered by PhilHealth. The Malasakit Centers Act mandates the establishment of one-stop shops for medical and financial assistance. This one-stop shop consists of representatives from the Department of Health (DOH), PhilHealth, the Philippine Charity Sweepstakes Office (PCSO), and Department of Social Welfare and Development (DSWD).5 This article aims to recommend health care policies to improve the existing health financing mechanisms currently sought by patients to cover their medical expenses during an episode of illness.
Financial Stress ; Universal Health Care ; Health Expenditures