Objectives
Adequate prenatal and delivery care are vital components of successful maternal health care provision. Starting in 1998, two programs were widely expanded in the Philippines: a national health insurance program (PhilHealth); and a donor-funded franchise of midwife clinics (Well-Family Midwife Clinics). This paper examines population-level impacts of these interventions on achievement of minimum standards for prenatal and delivery care.
Methods
Data from two waves of the Demographic and Health Surveys, conducted before (1998) and after (2003) scale up of the interventions, are employed in a pre/post study design, using longitudinal multivariate logistic and linear regression models.
Results
After controlling for demographic and socioeconomic characteristics, the PhilHealth insurance program scale up was associated with increased odds of receiving at least four prenatal visits (OR 1.04 [95% CI 1.01–1.06]) and receiving a visit during the first trimester of pregnancy (OR 1.03 [95% CI 1.01–1.06]). Exposure to midwife clinics was not associated with significant changes in achievement of prenatal care standards. While both programs were associated with slight increases in the odds of delivery in a health facility, these increases were not statistically significant.
Conclusions
These results suggest that expansion of an insurance program with accreditation standards was associated with increases in achievement of minimal standards for prenatal care among women in the Philippines.
Background: Hypertension is the number one attributable risk factor for death throughout the world and a major contributor to morbidity, mortality, and increasing health care expenditures in the Philippines. Lack of access to outpatient antihypertensive medicines leads to avoidable disease progression and costly inpatient admissions. We estimated the cost to the Philippine Health Insurance Corporation (PhilHealth), which generally does not cover outpatient medicines, for inpatient care for hypertension and its sequelae.
The 2019 Philippine Universal Health Care Act (Republic Act 11223) was set for implementation in January 2020 when disruptions brought on by the pandemic occurred. Will the provisions of the new UHC Act for an improved health system enable agile responses to forthcoming shocks, such as this COVID-19 pandemic? A content analysis of the 2019 Philippine UHC Act can identify neglected and leverage areas for systems’ improvement in a post-pandemic world. While content or document analysis is commonly undertaken as part of scoping or systematic reviews of a qualitative nature, quantitative analyses using a two-way mixed effects, consistency, multiple raters type of intraclass correlation coefficient (ICC) were applied to check for reliability and consistency of agreement among the study participants in the manual tagging of UHC components in the legislation. The intraclass correlation reflected the individuals’ consistency of agreement with significant reliability (0.939, p < 0.001). The assessment highlighted a centralized approach to implementation, which can set aside the crucial collaborations and partnerships demonstrated and developed during the pandemic. The financing for local governments was strengthened with a new ruling that could alter UHC integration tendencies. A smarter allocation of tax-based financing sources, along with strengthened information and communications systems, can confront issues of trust and accountability, amidst the varying capacities of agents and systems.
Background: Accurate prognostic awareness (PA) is essential for cancer patients to make informed end-of-life care plans. However, patients may not homogeneously develop accurate PA, and predictors of PA transition patterns have never been studied. We aimed to identify PA transition patterns and their predictors over cancer patients' last 6 months.Methods: PA was categorized into four states: (1) unknown and not wanting to know;(2) unknown but wanting to know; (3) inaccurate awareness; and (4) accurate awareness. Change patterns in PA states were identified by examining the first and last estimations by multistate Markov modeling during 332 cancer patients' last 6 months. Predictors of patients' distinct PA transition patterns were determined by multinomial logistic regression focused on lagged modifiable time-varying independent variables.Results: We identified four change patterns in PA states: maintaining accurate PA (56.6%), gaining accurate PA (20.5%), still wanting but inaccurate PA (7.2%), and still not wanting to know PA (15.7%). Physicians were more likely to disclose prognosis to the maintaining-accurate-PA group than other groups. Patients with more anxiety symptoms were less likely to be in the still-not-wanting to-know-PA group than in the maintaining-accurate-PA and gaining-accurate PA groups (adjusted odds ratio [95% confidence interval]¼AOR [95% CI]: 0.86 [0.76, 0.98] and 0.87 [0.76, 1.00], respectively). Patients with more social support (AOR [95% CI]: 0.94 [0.89, 0.99]) were less likely to be in the still-not-wanting to-know-PA group than in the maintaining-accurate-PA group. Patients with longer post-enrollment survival or higher educational levels were less likely to be in the still-not-wanting-to-know-PA group than in the gaining-accurate-PA group or the still-wanting but inaccurate-PA group, respectively.Conclusions: Most patients maintained or gained accurate PA before death, but about one-fourth of patients still wanted to know but had inaccurate PA or did not want to know PA. Modifiable factors like physicians' prognostic disclosure, and patients' anxiety symptoms and social support predicted distinct PA transition patterns over cancer patients' last 6 months.
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