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Questions and Answers
Such a referral system can cut short waiting times, lead to timely care, prevent duplication of diagnostic tests and procedures, and even improve the course of treatment. Patients often bypass the first (primary care) level to seek care in hospitals, as there is no effective ______ system or gatekeeping at the primary care level, which also contributes to inefficiencies and increasing cost of care.
referral
For instance, patients with easily treatable conditions like simple pneumonia bypass the primary care level and are admitted to hospitals by being ______.
up-coded
Investments in health infrastructure and human resources must also be continued and sustained to narrow the gap in utilization of health services between urban and rural areas. As the DOH has intended, the upgraded local health facilities should get PhilHealth ______, and income from PhilHealth should be retained to sustain the operations of health facilities, especially in isolated and hard-to-reach areas.
accreditation
Another set of challenges lies in implementing the National Health Insurance Program to provide financial risk protection and leverage its payments to ensure quality and responsive ______.
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The different membership contribution rates of PhilHealth engender ______.
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Patients often bypass the first (primary care) level to seek care in hospitals, as there is no effective referral system or ______ at the primary care level, which also contributes to inefficiencies and increasing cost of care.
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The service charges set by the hospital, which are not covered by PhilHealth case rate payment, are billed to the patient and outside-hospital purchases continue to ______ patients.
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The limited number of health facilities relative to the growing population, overprovision of physicians, underprovision of care and poor physician adherence to clinical practice guidelines contribute to a low quality of ______.
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Lessons learnt from health system reforms: The Government’s aspirations to improve health outcomes, provide protection from the impoverishing effects of increasing cost of care and ensure responsiveness of the health system to the population’s health needs were embodied in several iterations of its health reform ______.
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The DOH was successful in generating political and financial support to pursue KP and in legislating various policy proposals, most notably the Sin Tax Law and the Reproductive Health Law. However, strong political support and wider fiscal space do not automatically impact on health system performance, as there is lack of institutional capacity to translate policy into effective programme implementation, monitoring and ______.
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For instance, while PhilHealth’s membership coverage has expanded and its payment mechanism has improved, PhilHealth’s strategic purchasing has yet to assure its members of affordable, comprehensive and quality health ______.
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The Government’s aspirations to improve health outcomes, provide protection from the impoverishing effects of increasing cost of care and ensure responsiveness of the health system to the population’s health needs were embodied in several iterations of its health reform ______.
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Addressing health system inefficiencies and health inequities due to __________ governance remain critical challenges to the Philippine health system.
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PhilHealth, DOH and LGU health facilities are spending on the same maternal and child health services while the growing cases of ________, including the emergency care these conditions often require, are inadequately funded and poorly prioritized.
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Parallel funding by three sources (DOH, PhilHealth and LGU) and lack of demarcation and harmonization in premium-funded benefits versus tax-funded services are the primary reasons for confusion and inefficiencies in Philippine ______ financing.
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Engaging the private sector in delivering health care in the UHC context requires strong ______ capacity.
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The absence of a facilitated referral system robs the patient of the opportunity to navigate the health system effectively – from identifying the appropriate health-care provider, to getting advice on needed medical tests or procedures and referral back from hospitals to primary care for continued ______.
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Devolved and pluralistic service delivery remain critical challenges to the Philippine health system due to _________ governance.
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