The Cost of Primary Care: An Experience Analysis in an Urban Setting

Authors

  • Mia P. Rey, PhD Virata School of Business, University of the Philippines Diliman, Quezon City, Philippines
  • Regine Ynez H. De Mesa, BA Philippine Primary Care Studies, Center for Integrative and Development Studies, University of the Philippines Diliman, Quezon City, Philippines
  • Jose Rafael A. Marfori, MD, MPH Philippine Primary Care Studies, Center for Integrative and Development Studies, University of the Philippines Diliman, Quezon City, Philippines
  • Noleen Marie C. Fabian Philippine Primary Care Studies, Center for Integrative and Development Studies, University of the Philippines Diliman, Quezon City, Philippines; College of Nursing, University of the East Ramon Magsaysay Medical Center, Inc., Quezon City, Philippines https://orcid.org/0000-0002-8028-6242
  • Romelei Camiling-Alfonso, MD, MPM Philippine Primary Care Studies, Center for Integrative and Development Studies, University of the Philippines Diliman, Quezon City, Philippines
  • Ramon Pedro P. Paterno, MD National Institutes of Health, University of the Philippines Manila, Manila, Philippines
  • Nanette B. Sundiang, MD, MBA-H Philippine Primary Care Studies, Center for Integrative and Development Studies, University of the Philippines Diliman, Quezon City, Philippines
  • AB Yusoph, MA Department of Accounting, Bocconi University, Milan, Italy
  • Leonila F. Dans, MD, MSc Department of Pediatrics, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
  • Cara Lois T. Galingana, BS Philippine Primary Care Studies, Center for Integrative and Development Studies, University of the Philippines Diliman, Quezon City, Philippines
  • Ma. Rhodora N. Aquino, BS Philippine Primary Care Studies, Center for Integrative and Development Studies, University of the Philippines Diliman, Quezon City, Philippines
  • Josephine T. Sanchez, BS Philippine Primary Care Studies, Center for Integrative and Development Studies, University of the Philippines Diliman, Quezon City, Philippines
  • Jesusa T. Catabui, MD University Health Service, University of the Philippines Diliman, Quezon City, Philippines
  • Antonio Miguel L. Dans, MD, MSc Department of Medicine, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines

DOI:

https://doi.org/10.47895/amp.vi0.6589

Keywords:

primary care, experience analysis, primary care cost, health policy, healthcare financing, cost, and cost analysis

Abstract

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).

Downloads

Published

2024-12-18

Issue

Section

Articles

How to Cite

1.
The Cost of Primary Care: An Experience Analysis in an Urban Setting . Acta Med Philipp [Internet]. 2024 Dec. 18 [cited 2025 Apr. 3];58(23). Available from: https://actamedicaphilippina.upm.edu.ph/index.php/acta/article/view/6589

Most read articles by the same author(s)

1 2 > >>