BACKGROUND : The Indonesian chronic disease management program (PROLANIS) was introduced to provide structured chronic disease management for hypertension and type 2 diabetes (T2D) at the primary healthcare level. This study aimed to evaluate the health-related outcomes of PROLANIS among T2D patients in the eastern border region. METHODS : This retrospective cohort study used secondary data from PROLANIS reports of all primary healthcare facilities in Atambua Regency, East Nusa Tenggara Province, Indonesia. Inclusion criteria were all T2D patients who participated in routine 6-month evaluations conducted between June 2023 and December 2023. The assessed parameters and their defined targets were body mass index (BMI) (18.5–23 kg/m²), systolic blood pressure (SBP) (<140 mmHg), diastolic blood pressure (DBP) (<90 mmHg), hemoglobin A1c (HbA1c) (<7%), total cholesterol (TC) (<200 mg/dl), high-density lipoprotein (HDL) (>40 mg/dl for males and >50 mg/dl for females), low-density lipoprotein (LDL) (<100 mg/dl), and triglycerides (TGs) (<150 mg/dl). Wilcoxon signed-rank and paired t-tests were used for statistical analyses. RESULTS : There were 51 T2D patients included in the analyses. Of these, 84% achieved SBP and 96% achieved DBP targets. However, only 45% achieved HbA1c, and 33% achieved BMI targets. For lipid profiles, 55%, 51%, 47%, and 41% achieved TC, LDL, HDL, and TG targets, respectively. No significant differences were found between baseline and follow-up across these parameters (all p>0.05). CONCLUSIONS In the border region, while PROLANIS maintains blood pressure levels, it does not significantly improve other health-related outcomes in T2D patients. This underscores the need to strengthen program intensity, support adherence, and address contextual barriers to achieve meaningful metabolic improvements.
chronic disease ; government programs health services ; Indonesia ; primary healthcare ; type 2 diabetes mellitus

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

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).

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: The medical service delivery system in Korea works inefficiently and patients tend to visit tertiary hospitals by means of the emergency department (ED). Overcrowding of the ED threatens the health and life of emergency patients as a result of the inability to effectively distribute emergency medical resources in the community. To solve this problem, improvement in the medical delivery system and dispersion of patients by strengthening primary care may be helpful. In order to make policy decisions for this, it is necessary to estimate the scale of patients who can be distributed to primary care.METHODS: From January 1 to December 31, 2016, we analyzed the National Emergency Department Information System (NEDIS) data of patients who visited a tertiary ED to examine the proportion of patients eligible for primary medical care. The inclusion and exclusion criteria for primary care were made through the consensus of three physicians.RESULTS: A total of 65,061 NEDIS records were analyzed. Among them, by inclusion criteria, 29,818 cases were Korean Triage and Acuity Scale level 4 and 5, and 11,791 patients visited the ED during the day. After considering the exclusion criteria, there were 6,468 cases who may be suitable for primary medical care.CONCLUSION: Of the patients who visited the ED of tertiary hospitals, approximately 10% of them may be suitable for primary care. There should be a discussion and social consensus to reduce overcrowding in EDs and deliver better medical services.
Consensus ; Emergencies ; Emergency Service, Hospital ; Humans ; Information Systems ; Korea ; Primary Health Care ; Tertiary Care Centers ; Tertiary Healthcare ; Triage

The recent outbreak of Middle East respiratory syndrome coronavirus (MERS-CoV) infections in South Korea in May 2015 revealed that the Korean healthcare system and hospitals are highly vulnerable to hospital-spread infections. In a short period of time, MERS-CoV infection spread widely across Korea due to the unique characteristics of the Korean healthcare system including 1) hospitals with limited infection control capabilities, 2) a heavy dependency on private caregivers due to a nursing shortage, 3) emergency department overcrowding, and 4) healthcare-related patient behaviour such as hospital shopping. To prevent future outbreaks of emerging infectious diseases similar to MERS-CoV, the Korean healthcare system should be reformed and healthcare-related patient behaviour must change. To improve the performance of hospital infection control, the National Health Insurance service should pay more for hospital infection control services and cover private patient rooms when medically necessary, including for infectious disease patients. To reduce risks of hospital infection related to private caregiving, the nurse staffing level should be increased and hospitals should take full responsibility for inpatient nursing care. To reduce hospital shopping, the National Health Insurance service should introduce a differential fee schedule which pays more when primary care providers care for patients with common conditions and tertiary care providers care for patients with severe conditions. To incentivize patients for appropriate health care use, lower patient out-of-pocket payments should be combined with a differential provider fee schedule.
Caregivers ; Communicable Diseases ; Communicable Diseases, Emerging ; Coronavirus ; Cross Infection* ; Delivery of Health Care* ; Disease Outbreaks ; Emergency Service, Hospital ; Fee Schedules ; Hospital Shops ; Humans ; Infection Control ; Inpatients ; Korea ; Middle East* ; National Health Programs ; Nursing ; Nursing Care ; Patients' Rooms ; Primary Health Care ; Tertiary Healthcare

Lively discussion has been underway regarding primary care in South Korea as an alternative medical policy in the face of rising medical costs and health care disparities. However, the lack of research about primary care in South Korea makes it difficult to move policymakers, so it is time to enhance primary care research in South Korea. Primary care research can be defined as research directed toward the better understanding and practice of the primary care function. Primary care research traditionally has included basic research, clinical research, health services research related to primary care, health systems research, and research on primary care training; and each field is complementary. In primary care research, participation of primary care physicians is essential because primary care research is different from other conventional studies of disease prevalence, patient characteristics, diagnostic methods, and the treatment environment. Primary care research findings in other countries cannot be applied to South Korea as the characteristics of the health system and medical practice are different. To enhance the research on primary care in South Korea, financial assistance, promoting the research capacity of primary care physicians, and more attention from primary care physicians to research are needed.
Health Services Research ; Healthcare Disparities ; Humans ; Physicians, Primary Care ; Prevalence ; Primary Health Care ; Republic of Korea

BACKGROUND: This study aimed to evaluate the prevalence of Mycoplasma pneumoniae in primary and tertiary care hospitals and its macrolide resistance rate. METHODS: Nasopharyngeal swabs were collected from 195 pediatric patients in primary and tertiary care hospitals from October to November 2010. The AccuPower MP real-time PCR kit (Bioneer, Korea) was used for the detection of M. pneumoniae. Direct amplicon sequencing was performed to detect point mutations conferring resistance to macrolides in the 23S rRNA gene. RESULTS: Among the 195 specimens, 17 (8.7%) were M. pneumoniae positive, and 3 of the strains (17.6%) obtained from these 17 specimens displayed the A2063G mutation in 23S rRNA. Three macrolide-resistant M. pneumoniae isolates were isolated from patients hospitalized at the primary care hospital. The positive rates of M. pneumoniae for the primary and tertiary care hospitals were 12.1% (15/124) and 2.8% (2/71), respectively (P=0.033). CONCLUSIONS: The positive rate of M. pneumoniae in the primary care hospital was higher than that in the tertiary care hospital. Simultaneous detection of M. pneumoniae and macrolide-resistant mutation genes in the 23S rRNA by real-time PCR is needed for rapid diagnosis and therapy of M. pneumoniae infections.
Anti-Bacterial Agents/*pharmacology ; Child, Preschool ; Drug Resistance, Bacterial/*drug effects ; Female ; Humans ; Infant ; Infant, Newborn ; Macrolides/*pharmacology ; Male ; Mycoplasma pneumoniae/genetics/*isolation & purification ; Nasopharynx/microbiology ; Pneumonia, Mycoplasma/epidemiology/microbiology ; Primary Health Care ; RNA, Ribosomal, 23S/analysis ; Reagent Kits, Diagnostic ; Real-Time Polymerase Chain Reaction ; Tertiary Healthcare

The role of physicians in reducing health inequity has been regarded only partial and anecdotal by most policymakers. Clinicians, primary care physicians in particular, do not have sufficient opportunities to be engaged in activities dealing with health equity. However, physicians are playing a key role in providing health care and health-related programs, usually interwoven with inequities in health and health care utilization. As a result, a more active role for physicians must be identified under the scheme of a comprehensive strategy in combating inequity in health. From the perspective of mediating factors linking social determinants of health and inequitable outcomes in health and health care, health behaviors, access, and processes of care are identified as potential areas for physicians' engagement. 'Health equity capacity' is emphasized as a cross-cutting tool to empower physicians to address inequity in their clinical practices. More broadly, practicing physicians are able to support their colleagues and communities through diverse activities and participation: technical assistance, research and education, community involvement, and advocacy. Among them, raising awareness and changing perceptions are indicated as crucial factors facilitating physicians' contribution to minimizing inequity.
Clinical Competence ; Delivery of Health Care ; Health Behavior ; Health Status Disparities ; Healthcare Disparities ; Humans ; Negotiating ; Physicians, Primary Care ; Professional Role ; Socioeconomic Factors

BACKGROUND/AIMS: Rome criteria classifying functional gastrointestinal disorder (FGID) were updated. The aims of this study were to assess the spectra of FGID and to evaluate the applicability of Rome III criteria in Korea. METHODS: New patients who visited 2 primary clinics and 2 tertiary care hospitals were consecutively invited to complete questionnaires. These consisted of questionnaires for FGID based on Rome III criteria and symptom checklist-90-revised for somatization, depression and anxiety. RESULTS: A total of 786 patients was participated. Among them, FGID was observed in 49.7%. In the patients with FGID, functional dyspepsia was most common (46.0%) followed by irritable bowel syndrome (IBS, 40.2%). Functional dyspepsia was most common both in the primary care clinics and tertiary care hospitals. Postprandial distress syndrome was the most common subtype and the frequency of epigastric pain syndrome was low. There were few responders for constipation as Bristol types 1 and 2 and for diarrhea as types 6 and 7 in subtype classification using the Bristol Stool Form Scale. Thereby, unspecified IBS defined by stool form was unexpectedly common in 43.9% of IBS, whereas unspedified IBS defined by Rome III definition was 5.1%. Patients with overlap FGIDs had higher score of anxiety, depression or somatization. CONCLUSIONS: FGIDs were common both in primary care clinics and tertiary care hospitals of Korea. Overlap FGIDs is still common by Rome III criteria, which may limits its wide application.
Anxiety ; Constipation ; Depression ; Diarrhea ; Dyspepsia ; Gastrointestinal Diseases ; Humans ; Irritable Bowel Syndrome ; Korea ; Primary Health Care ; Surveys and Questionnaires ; Rome ; Tertiary Healthcare