BACKGROUND

Access to prison healthcare and healthcare equity remains poorly understood in the Philippines. With Philippine jail health systems subjected to budgetary restrictions, optimization of efficient mechanisms in healthcare delivery is warranted. This makes understanding how PDLs’ utilization to healthcare services more relavant and of high importance.

This study sought to determine healthcare accessibility and explored what influences healthcare access by Persons Deprived of Liberty (PDLs). Additionally, the study looked into whether healthcare was equally accessible to different PDL subgroups.

A descriptive-correlational design was employed in recruiting 261 PDLs utilizing stratified random sampling in two jail facilities in Dumaguete City from May to June 2023. Data on healthcare accessibility and availability from self-report survey questionnaires were analyzed using SPSS version 25.

Hierarchical linear regression analysis shows that, collectively, predisposing factors (age, sex) F=200.82, enabling resources (availability of health services) F=52.52, and perceived needs (physical activities, sleep, diet, and mental health) F=30.24 significantly predict healthcare accessibility, having the availability of healthcare services as the strongest predictor with an R2 change of 43.7% followed by percieved needs (3.9%) and predisposing factor (1.4%), respectively. Furthermore, ordinal logistic regression analysis shows that healthcare by age groups 18-34 (OR=0.379) and 35-54 (OR=0.449) are less likely to be available and accessed than those aged 55 and above. Additionally, availability and accessibility of healthcare are less likely for males (OR=0.24) than females while PDLs with average physical activities (OR=0.87), good (OR=50.7) to average sleep (OR=27.4), and average mental health (OR=0.35) have higher odds of availing and accessing healthcare than their poor counterparts.

These findings indicate that PDLs tend to access healthcare services based predominantly on availability rather than their desired needs warranting strategies that allow catering to a wide range of health needs in PDL subgroups which ultimately lead to better prison health outcomes.

BACKGROUND

The pharmaceutical subsystem is a complex interrelationship among different stakeholders that ensure access to safe, effective, and quality pharmaceutical products in the market. Understanding the availability and affordability as key areas for access to medicines is essential to appreciate the strategies needed to strengthen the pharmaceutical subsystem.

This study aimed to determine the availability and affordability of essential antihypertensive medicines in public primary care facilities and private retail drugstores in a 4th class municipality. Further, the study determined the price comparisons of these essential antihypertensive medicines with international reference prices.

This is a quantitative, cross-sectional study design which employed a modified WHO/HAI methodology to quantify antihypertensive medicines’ availability and affordability in public and private primary care drug facilities. Selection of medicines was based on a criteria applicable for the primary care setting. Availability was measured through visual inspection of the selected medicines in the facility, affordability was estimated through the selling price of medicines in the public and private facilities, respectively, and was divided by the local minimum wage of the municipality. Median price ratio was computed using the local median prices over the MSH 2015 international reference prices adjusted for inflation.

Availability of essential antihypertensive medicines was found to be 12.96% in public facilities and 60.32% in private facilities (p=0.0002). Only amlodipine is observed to be available in both public (83.33%) and private (85.71%) facilities, while only metoprolol 50 mg tab (33.33%) and amlodipine 5 mg tab (83.33%) were available in public facilities. All medicines are below 1 MPR, but carvedilol 6.25 mg (1 tab BID: 1.32; 2 tabs BID: 2.65), 25 mg (BID: 2.65), and enalapril 5 mg (BID: 1.14; TID: 1.70) treatment regimens are unaffordable compared to a worker’s day wage.

Availability of essential antihypertensive medicines is diverse comparing public and private facilities. There is a need to increase the availability of antihypertensive medicines in public facilities as this is an important quality measure of primary care services. Public facilities can leverage on the availability of medicines in private pharmacies by forming Primary Care Provider Networks. While most medicines were deemed affordable in the private setting, there are still drugs such as carvedilol and enalapril, that need to be regulated. There is a need to strengthen the local pharmaceutical subsystem because it is essential to ensure safe, effective, and quality medicines in the local health system through adequate mobilization of resources.

Background: The pharmaceutical subsystem is a complex interrelationship among different stakeholders that ensure access to safe, effective, and quality pharmaceutical products in the market. Understanding the availability and affordability as key areas for access to medicines is essential to appreciate the strategies needed to strengthen the pharmaceutical subsystem. Objectives: This study aimed to determine the availability and affordability of essential antihypertensive medicines in public primary care facilities and private retail drugstores in a 4th class municipality. Further, the study determined the price comparisons of these essential antihypertensive medicines with international reference prices. Methods: This is a quantitative, cross-sectional study design which employed a modified WHO/HAI methodology to quantify antihypertensive medicines’ availability and affordability in public and private primary care drug facilities. Selection of medicines was based on a criteria applicable for the primary care setting. Availability was measured through visual inspection of the selected medicines in the facility, affordability was estimated through the selling price of medicines in the public and private facilities, respectively, and was divided by the local minimum wage of the municipality. Median price ratio was computed using the local median prices over the MSH 2015 international reference prices adjusted for inflation. Results: Availability of essential antihypertensive medicines was found to be 12.96% in public facilities and 60.32% in private facilities (p = 0.0002). Only amlodipine is observed to be available in both public (83.33%) and private (85.71%) facilities, while only metoprolol 50 mg tab (33.33%) and amlodipine 5 mg tab (83.33%) were available in public facilities. All medicines are below 1 MPR, but carvedilol 6.25 mg (1 tab BID: 1.32; 2 tabs BID: 2.65), 25 mg (BID: 2.65), and enalapril 5 mg (BID: 1.14; TID: 1.70) treatment regimens are unaffordable compared to a worker’s day wage. Conclusion Availability of essential antihypertensive medicines is diverse comparing public and private facilities. There is a need to increase the availability of antihypertensive medicines in public facilities as this is an important quality measure of primary care services. Public facilities can leverage on the availability of medicines in private pharmacies by forming Primary Care Provider Networks. While most medicines were deemed affordable in the private setting, there are still drugs such as carvedilol and enalapril, that need to be regulated. There is a need to strengthen the local pharmaceutical subsystem because it is essential to ensure safe, effective, and quality medicines in the local health system through adequate mobilization of resources.
Human ; access to medicines ; health services accessibility ; affordability ; costs and cost analysis

Medical assistance programs are government-funded programs that provide financial assistance to low-income individuals and families. These programs aim to reduce financial burdens and improve health care access. Coverage may include outpatient visits, hospital care, mental health services, diagnostic work-ups, prescriptions, and other services. This increases the detection of health conditions and improves drug utilization.1 2 3 Even though government health schemes and compulsory contributory health care financing schemes (e.g., PhilHealth) accounted for the majority of health expenditures in the Philippines, household out-of-pocket (OOP) payment still remains high. In 2022, the country’s total health expenditure (THE) was Php 1.12 trillion, with government health schemes and compulsory contributory health care financing schemes accounting for 44.8% of the THE and household OOP payment accounting for 44.7%. Thus, every Filipino spent an average amount of Php 10,059.49 for health care goods and services in 2022
Medical Assistance ; Health Services Accessibility ; Mental Health Services

Background: Tiered services, differentiated by the financial capacity of patients and related payment arrangements with hospitals, are the norm in Philippine facilities. This study considered how these, together with selected demographic and clinical factors, were associated with surgical care utilization, provision, and outcomes for patients with appendicitis in a public university hospital.

Methods: This was a retrospective cohort study, utilizing data obtained from an electronic patient registry. Patients who underwent emergent appendectomies from January 2017 to December 2018 were included. Data were analyzed using multivariate and logistic regression, with the following dependent variables: time from symptom onset to emergency department consultation (ED Lag), time from consult to surgery (OR Lag), selection for laparoscopic appendectomy (LA), the occurrence of complicated appendicitis (CA), and length of stay (LOS). Morbidities and mortalities were tallied.

Results: There were 1,501 patients included in the study. Young adult males comprised the majority and mostly had non-private accommodations. Non-CA was the impression in more than 80% of cases. Extremes of age were associated with longer ED and OR Lags, greater likelihood of CA, and longer LOS. Patients initially assessed as having CA had shorter OR Lags, were less likely to undergo LA, and had longer LOS. Private patients were more likely to have undergone LA, lower CA odds, and slightly longer LOS.

Conclusions: Variations in surgical care utilization, provision, and outcomes for patients with appendicitis were independently associated with socioeconomic and clinical status differences.

Objective: To analyze the epidemiological characteristics of pneumoconiosis in Qinghai Province from 2011 to 2020, and to provide a basis for the formulation of prevention and control strategy. Methods: In April 2021 , the cases of pneumoconiosis were monitored by the Occupational Disease and Health Hazard Factors Monitoring Information System in Qinghai Province from 2011 to 2020. The distribution of pneumoconiosis, the composition of diseases and the working years exposed to dust were analyzed. Results: All 1026 cases of pneumoconiosis were newly diagnosed in Qinghai Province from 2011 to 2020, silicosis and coal worker pneumoconiosis were the main diseases (78.36% ,804/1026). Stage Ⅰ pneumoconiosis were 484 (47.17%,484/1026) cases. 359 (34.99%,359/1026) cases, 315 (30.70%,315/1026) cases and 252 (24.56%, 252/1026) cases had been diagnosed respectively in Xining City, Haidong City and Haixi Prefecture; 628 (61.21%,628/1026) cases and 418 (40.74%, 418/1026) cases engaged in mining industry and large-sized enterprise, respectively. The working years exposed to dust in silicosis cases were shorter than that in coal worker pneumoconiosis and other pneumoconiosis (P <0.05). Conclusion: The pneumoconiosis area and industry focus in Qinghai Province is obvious. The supervision and adninistration of small and micro scale employers should be strengthened to protect the health rights and interests of workers, especially for the key area and industry.
Anthracosis/epidemiology* ; China/epidemiology* ; Coal Mining ; Dust ; Health Services Accessibility ; Human Rights ; Humans ; Pneumoconiosis/epidemiology* ; Silicosis/epidemiology*

Objective: To understand the current situation and influencing factors of cervical and lumbar spine diseases of the express delivery employees, and provide scientific basis for carrying out their occupational health protection in a targeted manner. Methods: From February 2020 to January 2021, the current situation research method was used to obtain 527 express delivery employees by cluster sampling. Online questionnaires were used to investigate sociodemographic characteristics and emotional characteristics, and clinical data were obtained by digital X-ray (DR) examination of the neck and waist. Pearson χ(2) test and multivariate logistic regression were used to analyze the influencing factors of cervical and lumbar spine diseases in express delivery employees. Results: The prevalence rates of cervical spine and lumbar spine diseases among express delivery employees were 49.15% (259/527) and 67.74% (357/527) , respectively. Univariate analysis showed that there were statistically significant differences in the distribution of cervical and lumbar spine disease among express delivery employees with different ages, length of service, working hours per week, and different degrees of distress due to emotional factors (P<0.05) . Multivariate analysis showed that express delivery employees aged ≥25 years old had a higher risk of cervical spine disease (P<0.05) , the express delivery employees who worked 49-55 hours per week had a lower risk of cervical spine disease (P<0.05) . Express delivery employees aged≥35 years old had a lower risk of lumbar spine disease (P<0.05) , and the risk of lumbar spine disease was higher among express delivery workers who suffered moderate or more distress due to emotional factors (such as anxiety, depression, or irritability) in the past 4 weeks (P<0.05) . Conclusion: The prevalence of cervical and lumbar spine diseases is relatively high among express delivery employees. It is recommended to adjust the weekly working hours of express delivery employees, organize psychological counseling training, and effectively protect the occupational health rights of express delivery employees.
Adult ; Health Services Accessibility ; Human Rights ; Humans ; Occupational Health ; Prevalence ; Surveys and Questionnaires

Background: The enactment of the Universal Health Care Act is anticipated to bring wider coverage and accessibility of quality healthcare services as stipulated in its objectives. With the integration of the healthcare system at the provincial level, determining population- and individual-based services is crucial in mapping the managerial and financial roles. Hence, this study aimed to establish the criteria for identifying population-based and individualbased health services in the Philippines. Methods: A systematic review of literature was conducted to generate evidence for the policy brief and discussion points on the roundtable discussion spearheaded by the UP Manila Health Policy Development Hub in collaboration with the Department of Health. Key stakeholders of the policy issue convened to share expertise and insights in determining criteria for population- and individual-based services, intending to generate consensus policy recommendations. Results: The general scope of individual-based health services stipulated in the Law are to be financed under the benefit packages of PHIC and HMOs. Meanwhile, population-based services are those that address public health issues such as health promotion and disease surveillance. Several services considered as ‘grey areas’ are those that fall in the overlap of the individual- and population-based services. These services may be examined through an outcome-based algorithm that examines fragmentation issues both in the supply and demand side of service delivery. Conclusion and Recommendation Proposed criteria in identifying individual- and population-based services include the number of recipient/s, the effectivity of service delivery and utilization, and source of funding. Health programs that are in the grey areas can be examined through an outcome-based algorithm.
Healthcare Financing ; Health Services Accessibility

Background: Rabies continues to circulate in low levels through the years. It is continuing to be a public health problem in the Philippines.1,2 The Philippine government created programs, which provided guidelines and tasked several agencies in a collective effort to prevent and control rabies with the aim of declaring the Philippines rabies-free by 2020. Despite this, increase in cases have been noted.2,3,4 Objectives: This study aimed to describe demographics and explore the level of access to care as perceived by the animal bite patients in terms of accessibility, availability, and affordability of vaccine, animal bite treatment center and health worker influencing the control of rabies, which could be useful in the improvement of strategies in the management thereof Results: The study included 71 respondents. 69% were adults and majority live within Baguio City, within the 5km radius from the ABTC. 81.7% can easily obtain ARV from the conveniently accessible ABTC, which is manned by effective health workers. Majority claimed that the vaccine are readily available on the spot and they predominantly paid about Php 1000-2000. Only 14.1% were able to have free vaccine and less than half of the respondents had no problem with affording hospital costs. 18.3% claimed that opening hours of ABTC are in conflict with their schedule. Conclusion The access to care in the control of rabies is important to the health care delivery system. Improvement in the control of rabies underscoring the factors such as distribution, coverage, health care workers, price and supply are avenues to advance efforts in the achievement of the program goal
Health Services Accessibility

Blood Pressure Monitoring, Ambulatory ; COVID-19/therapy* ; Cardiac Rehabilitation ; Cardiovascular Diseases/therapy* ; Communicable Disease Control ; Contact Tracing ; Health Literacy ; Health Services Accessibility ; Healthcare Disparities ; Humans ; Internet Access ; Poverty ; SARS-CoV-2 ; Singapore ; Social Class ; Social Conditions ; Socioeconomic Factors ; Telemedicine ; Telerehabilitation ; Transients and Migrants