Promoting equitable and patient-centred care: an analysis of patient satisfaction in urban, rural and remote primary care sites in the Philippines.

OBJECTIVES: This study measured changes in patient satisfaction levels before and after the introduction of primary care system strengthening interventions in urban, rural, and remote sites in the Philippines. METHODS: A previously validated 16-item questionnaire was distributed to 200 patients per site before implementation of interventions and to a different set of 200 patients 1 year after implementation. We compared the percentage change in highly satisfied patients per site before and after implementing interventions using a two-proportion Z-test. RESULTS: The urban site had a significant increase in patient satisfaction in 13 survey items, which corresponded to the domains of healthcare availability, service efficiency, technical competency and health communication. The rural site had a significant increase in six survey items, which corresponded to the domains of service efficiency, environment, location, health communication and handling. The remote site had a decrease in patient satisfaction in 10 survey items, with a significant increase in only 4 items under the domains of healthcare availability and handling. CONCLUSION: Our findings support the 'inverse equity hypothesis', where well-resourced urban communities quickly adopt complex health interventions while rural and remote settings experience delays in effectively meeting patient needs and system demands. Extended intervention periods and targeted strategies may be necessary to impact patient satisfaction in underserved areas considerably.

Experiences from the Philippine grassroots: impact of strengthening primary care systems on health worker satisfaction and intention to stay.

BACKGROUND: Inequities in health access and outcomes persist in low- and middle-income countries. While strengthening primary care is integral in improving patient outcomes, primary care networks remain undervalued, underfunded, and underdeveloped in many LMICs such as the Philippines. This paper underscores the value of strengthening primary care system interventions in LMICs by examining their impact on job satisfaction and intention to stay among healthcare workers in the Philippines. METHODS: This study was conducted in urban, rural, and remote settings in the Philippines. A total of 36 urban, 54 rural, and 117 remote healthcare workers participated in the study. Respondents comprised all family physicians, nurses, midwives, community health workers, and staff involved in the delivery of primary care services from the sites. A questionnaire examining job satisfaction (motivators) and dissatisfaction (hygiene) factors was distributed to healthcare workers before and after system interventions were introduced across sites. Interventions included the introduction of performance-based incentives, the adoption of electronic health records, and the enhancement of diagnostic and pharmaceutical capabilities over a 1-year period. A Wilcoxon signed-rank test and a McNemar's chi-square test were then conducted to compare pre- and post-intervention experiences for each setting. RESULTS: Among the factors examined, results revealed a significant improvement in perceived compensation fairness among urban (p = 0.001) and rural (p = 0.016) providers. The rural workforce also reported a significant improvement in medicine access (p = 0.012) post-intervention. Job motivation and turnover intention were sustained in urban and rural settings between periods. Despite the interventions introduced, a decline in perceptions towards supply accessibility, job security, and most items classified as job motivators was reported among remote providers. Paralleling this decline, remote primary care providers with the intent to stay dropped from 93% at baseline to 75% at endline (p < 0.001). CONCLUSION: The impact of strengthening primary care on health workforce satisfaction and turnover intention varied across urban, rural, and remote settings. While select interventions such as improving compensation were promising for better-supported settings, the immediate impact of these interventions was inadequate in offsetting the infrastructural and staffing gaps experienced in disadvantaged areas. Unless these problems are comprehensively addressed, satisfaction will remain low, workforce attrition will persist as a problem, and marginalized communities will be underserved.

PhilHealth's financial position: A descriptive study based on Commission on Audit (COA) annual audit reports from 1999 - 2010

BACKGROUND: PhilHealth, a government owned and controlled corporation which runs the country's social health insurance program, has given conflicting impressions of its financial position in various public forums. This study aims to describe the financial position of PhilHealth up to 2010 based on COA audit reports. METHODS: Financial statements from Commision on Audit (COA) Annual Audit Reports on PhilHealth from the years 1999-2010 were reviewed to describe PhilHealth's financial position. RESULTS: Up to 2010, based on COA audited reports, PhilHealth was financially solvent. Its net financial worth has steadily increased to P106.9B in 2010. PhilHealth's sources of revenues were mainly from premiums (82.7%) and interest income (17.0%). From 2007-2010, 88.5% of PhilHealth's premiums came from paying members. Premiums of the informal sector made up only 4.7% of toal premiums. Expenses were made up of benefit payments and administrative expenditures. PhilHealth exceeded its allowed administrative expenses for the years 2004, 2008 and 2009. PhilHealth's stated reserve fund has steadily increased and had rearched P90.7B in 2010. Several questions, outside of the scope of an analysis of the COA audit reports and involving reimbursements and adminstrative expenses need further investigation. CONCLUSIONS AND RECOMMENDATIONS: At its level of purchasing up to 2010, PhilHealth was indeed sustainable. But as one of the three pillars of Kalusugan Pangkalahatan (KP), PhilHealth has to dramatically increase its share in the country's Total Health Expenditure. PhilHealth's financial position has to be continuously monitored as KP is being implemented.