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Fueling primary care through efficient health systems financing

By Carla Marie L. Asis and Leonila F. Dans

SUMMARY

Effective health systems rely on robust health financing to achieve universal health coverage (UHC). The Philippine Primary Care Studies (PPCS) examined the cost-effectiveness of a comprehensive primary care benefit package (PCBP) in the Philippines, finding a feasible initial per-capita cost but persistent out-of-pocket spending. The study highlighted the impact of utilization rates and scalability challenges in the context of varied geographic settings and family size. It emphasized the need for sustainable financing strategies, including adaptable budget allocation and targeted subsidies. This policy brief details specific recommendations to ensure long-term success of primary care financing in the Philippines.

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FINANCING PRIMARY HEALTH CARE

Health financing is a core function of effective health systems, playing a vital role in advancing universal health coverage (UHC). Insufficient public funding leads to fragmented health financing systems. Multiple funding streams and payment systems for varied services and populations create inefficiencies, mismatching resources with needs, leading to overuse of expensive services, and leaving the poor underserved. Currently, financial barriers prevent millions of people worldwide from accessing needed healthcare services, and many experience poor quality of care despite out-of-pocket (OOP) payments.

COST OF PRIMARY CARE IN THE PHILIPPINES

The Philippine National Health Insurance Program (PhilHealth) aims to provide affordable healthcare for all Filipinos, but its current structure heavily favors inpatient care, leaving outpatient services underfunded. This imbalance, coupled with the tendency for Filipino patients to bypass primary care centers for better-equipped tertiary facilities and to seek care from specialists, exacerbates existing healthcare worker shortages and maldistribution. The resulting gaps in outpatient financing contribute to high OOP healthcare expenses, disproportionately affecting marginalized populations.

The PPCS conducted a study that aimed to determine the cost of a comprehensive, disease- agnostic primary care benefit package (PCBP) during its first year of implementation at a government-run urban outpatient facility to inform more effective primary care financing strategies. Key findings are as follows:

  • Feasible Initial Cost: The study estimated a per-capita cost of PHP 403.22 for a comprehensive primary care package in an urban setting. The per-capita cost comprises consultations (PHP 271.30), diagnostic procedures (PHP 78.03), and medicines (PHP 53.90).
  • Persistent OOP Spending: Despite the implementation of the PCBP, a notable percentage of patients (0.36%) still incurred OOP expenses, exceeding the allocated capitation. This highlights the need for further measures to reduce financial burdens.
  • Cost Variability: The study highlights the impact of utilization rates on overall costs. Higher utilization, while indicating greater access to care, will lead to increased expenditures.
  • Scalability Challenges: Replicating the urban model in rural and remote areas presents unique challenges, requiring adaptations to address geographical barriers, infrastructural limitations, and variations in healthcare needs. Additionally, the per capita funding model may not adequately address the needs of larger families, who may face disproportionately higher healthcare costs.
  • Sustainability Concerns: The initial cost estimate might not fully account for long-term factors such as inflation, population growth, and technological advancements that impact healthcare delivery and infrastructure.

STRATEGIC BUDGET MANAGEMENT FOR PHILIPPINE PRIMARY CARE

POLICY IMPLICATIONS RECOMMENDATIONS
●        Adequate and adaptable budget allocation Allocate sufficient funds to cover the estimated per capita cost of a comprehensive primary care package (around PHP 403.22) adjusting for inflation, population growth, and location-specific variations.
●        Context-specific subsidies Introduce targeted subsidies or supplemental programs to specifically assist low-income families and individuals and mitigate out-of-pocket expenditures. Incorporate a family-based funding model to ensure more equitable financial protection for all household sizes.
●        Strengthen health insurance coverage Implement wider outreach programs and community education about insurance benefits. Invest in robust data collection systems, including electronic health records, to accurately monitor utilization rates, track patient expenses, and identify areas for improvement in the PCBP design.
●        Optimize resource utilization o    Opportunistic patient registration: Register patients at the time of their first consultation.

o    Reduce unnecessary check-ups: Focus on targeted check-ups based on patient characteristics such as age, sex, occupation, height, weight, tobacco exposure, and others as recommended in the Philippine Guideline for Periodic Health Examinations developed by the Department of Health.

o    Community engagement: Ensure that communities are well-educated on the benefit package to encourage responsible utilization. Create informational brochures, posters and videos, and hosting town hall meetings to explain the concept of risk-sharing.

o    Streamline processes: Utilize electronic health records for efficient management of patient facility experience, transactions, and fund disbursements.
●        Support a sustainable framework Explore alternative financing models, such as public-private partnerships or community-based financing schemes, to complement government

funding and ensure long-term financial sustainability.

 THE PATH FORWARD

Investing in comprehensive primary care is financially feasible and can improve health outcomes in the Philippine setting. However, a well-designed PCBP with strategic interventions and data-driven policies are needed to truly achieve UHC and reduce financial burden on individuals and families. Consistent monitoring and adaptation are crucial for long-term success.

 

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Citations

World Health Organization (2011). Monitoring the Building Blocks of Health Systems: A Handbook of Indicators and Their Measurement Strategies.

Rey, M. P., De Mesa, R. Y. H., Marfori, J. R. A., Fabian, N. M. C., Camiling-Alfonso, R., Paterno, R. P. P.,

Sundiang, N. B., Yusoph, A., Dans, L. F., Galingana, C. L. T., Aquino, M. R. N., Sanchez, J. T., Catabui, J. T., & Dans, A. M. L. (2024). The Cost of Primary Care: An Experience Analysis in an Urban Setting . Acta Medica Philippina. https://doi.org/10.47895/amp.vi0.6589