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.

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.

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 ;

On September 12, 2018, President Jae-In Moon announced the Comprehensive Plan for Lifelong Care for People with Developmental Disabilities, with representatives from the associated government branches (Ministry of Health and Welfare, Ministry of Education, and Ministry of Employment and Labor) in attendance. The goals of this plan are to provide health, medical, rehabilitative, special education, and social welfare services according to the life-stages of the affected individuals; to reduce parental pressure; to promote social interventions; and to enhance community-level participation in order to create a ‘welfare society in harmony.’ However, in order for the plan to succeed, additional efforts must be made in the following areas. First, an epidemiological survey is needed to understand the scale, prevalence, and incidence of developmental disabilities and to establish an evidence base to support policy development. Second, accurate definitions of developmental disabilities must be established in order to avoid policy discrimination based on impairment type and age. Third, personal evaluations to assess disabled individuals' unmet needs and customized service designs to deliver those needs are required. Fourth, the plan must fulfill the goals of accessibility and fairness that the government intends to provide. Fifth, the government should consider an integrated financial support system and to propose a detailed plan for monetary distributions. Finally, an integrated system that links health, medical, employment, educational, and welfare services must be constructed.
Comprehensive Health Care ; Developmental Disabilities ; Discrimination (Psychology) ; Education ; Education, Special ; Employment ; Financial Support ; Humans ; Incidence ; Intellectual Disability ; Moon ; Parents ; Policy Making ; Prevalence ; Social Welfare

Lung cancer is the most commonly diagnosed cancer and the leading cause of cancer-related deaths worldwide. Globally, there were an estimated 1.8 million new cases and 1.59 million deaths in 2012. In Korea, the incidence of lung cancer is increasing and 24,267 (47.6/100,000) patients with lung cancer were registered at the Korea Central Cancer Registry in 2015. Previous nationwide surveys of lung cancer were performed in 1998 by the Korean Academy of Tuberculosis and Respiratory Diseases and in 2007 by the Korean Association for Lung Cancer (KALC), but the studies faced difficulties in maintaining lung cancer registry because of limitations regarding the Private Information Protection Act. To produce unbiased and reliable epidemiological data, the KALC and Korean Central Cancer Registry developed a detailed lung cancer registry (KALC-R) data structure. Following a pilot survey of 489 lung cancer cases in 2013, about 10% of the sampled lung cancer cases from the Korean Central Cancer Registry are surveyed each year. With the analysis of detailed data from the KALC-R, an important epidemiological background for scientific research or policy development is expected to be generated.
Computer Security ; Humans ; Incidence ; Korea ; Lung Neoplasms ; Lung ; Policy Making ; Registries ; Tuberculosis

BACKGROUND AND OBJECTIVES: Percutaneous coronary intervention (PCI) is an indispensable treatment modality in coronary artery disease. However, there is still inadequacy of comprehensive knowledge on the Korean status and trend of this important procedure using nation-wide and representative data. METHODS: National Health Insurance Service-National Sample Cohort is a database containing demographic, health insurance reimbursement for patient management and health screening data of about one million Koreans for 12 years (2002–2013). Annual procedure rate for PCI was estimated by bootstrapping as per 100,000 person-years. RESULTS: Among the whole cohort, total 12,186 PCI's were done during the study period. Mean age of subjects who underwent PCI was 57.6±11.2 years and male:female proportion was 68%:32%. Death from all cause occurred in 1,843 (15.1%), death from ischemic heart diseases in 662 (5.4%), death from all cardiovascular cause in 872 (7.2%) during the follow-up. The proportion of the primary PCI for acute myocardial infarction was estimated to be 24.0%. Estimated annual rate of PCI increased from median 29.1 (95% confidence interval [CI], 26.6–32.1) in 2002 to 107.7 (95% CI, 103.0–113.8) per 100,000 person-years in 2013. In this cohort, PCI was performed in total 180 hospitals, which annually increased from 59 in 2002 to 153 in 2013. CONCLUSIONS: PCI had increased in volume from 2002 to 2013. This descriptive data may be considered in policy making and planning further direction of management of coronary artery disease in Korea.
Cohort Studies ; Coronary Artery Disease ; Follow-Up Studies ; Humans ; Insurance, Health, Reimbursement ; Korea ; Mass Screening ; Myocardial Infarction ; Myocardial Ischemia ; National Health Programs ; Percutaneous Coronary Intervention ; Policy Making

BACKGROUND: The purpose of this study is supposed to figure out the keyword network from 2009 to 2018 with social network analysis and provide the research data that can help the Korea government's policy making on smoking cessation. METHODS: First, frequency analysis on the keyword was performed. After, in this study, I applied three classic centrality measures (degree centrality, betweenness centrality, and eigenvector centrality) with R 3.5.1. Moreover, I visualized the results as the word cloud and keyword network. RESULTS: As a result of network analysis, ‘smoking’ and ‘smoking cessation’ were key words with high frequency, high degree centrality, and betweenness centrality. As a result of looking at trends in keyword, many study had been done on the keyword ‘secondhand smoke’ and ‘adolescent’ from 2009 to 2013, and ‘cigarette graphic warning’ and ‘electronic cigarette’ from 2014 to 2018. CONCLUSION: This study contributes to understand trends on smoking cessation study and seek further study with the keyword network analysis.
Korea ; Policy Making ; Smoke ; Smoking Cessation

BACKGROUND: The objectives of the study are to find out the effect of the implementing reform in three Central Asian countries, identify its impact on health status and health care delivery systems. This study address to identify strong and weak points of the health systems and provide a recommendation for further health care organization. METHODS: A comparative analysis was conducted to evaluate the effects of implemented policy on health care system efficiency and equity. Secondary data were collected on selected health indicators using information from the World Health Organization Global Health Expenditure Database, European Health Information Platform, and World Bank Open Data. RESULTS: In terms of population status, countries achieved relatively good results. Infant mortality and under-5 mortality rate decreased in all countries; also, life expectancy increased, and it was more than 70 years. Regulations of the health systems are still highly centralized, and the Ministry of Health is the main organ responsible for national health policy developing and implementation. Among the three countries, only Kyrgyzstan was successful in introducing a national health system. Distribution of health expenditure between public expenditure and out-of-pocket payments was decreased, and out-of-pocket payments were less the 50% of total health expenditure in all countries, in 2014. CONCLUSION: After independent, all three countries implemented a certain number of the policy reform, mostly it was directed to move away from the old the Soviet system. Subsequent reform should be focused on evidence-based decision making and strengthening of primary health care in terms of new public health concepts.
Asian Continental Ancestry Group ; Decision Making ; Delivery of Health Care ; Global Health ; Health Expenditures ; Health Policy ; Humans ; Infant ; Infant Mortality ; Kazakhstan ; Kyrgyzstan ; Life Expectancy ; Mortality ; Primary Health Care ; Public Health ; Social Control, Formal ; United Nations ; Uzbekistan ; World Health Organization

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

The Korean Medical Association (KMA) operates two organizations dedicated to healthcare policy research: the Research Institute for Healthcare Policy, which was launched in 2002, and the KMA Policy Special Committee, which was launched in 2017 as an administrative subunit of the board of representatives. Some members of the KMA have criticized the coexistence of two organizations for policy development. They argue that it would be preferable to unify these organizations, pointing out that having duplicate organizations for policy development wastes financial resources, disperses professionals, and produces different opinions on policies, which could be a source of confusion in the policy activities of the KMA. The author was a director in charge of policy at the KMA in 2002, when the Research Institute for Healthcare Policy was founded, and has also been an active member of the KMA Policy Special Committee since its launch in 2017. Having been involved in both policy development organizations, the author suggests that unifying these two organizations would not be desirable for the medical profession. The Research Institute for Healthcare Policy and the KMA Policy Special Committee are similar in that they deal with healthcare policy, but their approaches are quite distinct. The former organization must thoroughly research healthcare policy from a theoretical perspective, while the latter approaches healthcare policy by advocating for the interests of the members of the KMA. For instance, if the two organizations simultaneously research the possibility of a global budget payment system, the Research Institute for Healthcare Policy should address both its advantages and disadvantages, while the KMA Policy Special Committee would instead organize a policy initiative opposing a global budget payment system by focusing on its disadvantage of restricting the autonomy of healthcare providers. However, if the former organization provides a theoretical base and the latter organization coordinates policy advocacy in the interest of members of the KMA, the two organizations will make a major contribution to improving the medical environment in a complementary manner. In 2018, the two organizations jointly held a workshop with the theme of “shared growth”in Cheonan, demonstrating their ongoing efforts to collaborate. The author suggests that instead of becoming enmeshed in controversies about whether it should continue to exist as a separate organization, the KMA Policy Special Committee should instead focus on becoming the KMA's center for healthcare policy advocacy as soon as possible.
Academies and Institutes ; Budgets ; Chungcheongnam-do ; Delivery of Health Care ; Education ; Health Personnel ; Health Policy ; Humans ; Policy Making ; Professionalism