Social Medicine Unit, College of Medicine, University of the Philippines Manila, 547 P. Gil St., Ermita, Manila 1000 Philippines.
Soc Sci Med. 2012 Nov;75(10):1820-7. doi: 10.1016/j.socscimed.2012.07.027. Epub 2012 Aug 6.
The study was undertaken to determine, from the patient's perspective, the comparative effectiveness of locally established financial protection mechanisms particularly for indigent and severely-ill hospitalized patients. Data was obtained from a survey conducted in 2010 in Philippine provinces which were part of the Health Systems Development Project and involved 449 patients from selected private and public hospitals. Direct medical expenses incurred during the confinement period, whether already paid for prior to or only billed upon discharge, were initially considered. Expenses were found to be generally larger for the more severely ill and lower for the poor. Hospital-provided discounts and social health insurance (PhilHealth) reimbursements were the financial protection mechanisms evaluated in this study. In average terms, only up to 46% of inpatient expenses were potentially covered by the combined financial support. Depending on the hospital type, 28-42% of submitted PhilHealth claims were invalidated. Multiple linear regression analysis was utilized to determine the relationship of the same set of patients' demographic characteristics, socioeconomic status, severity of illness, and hospital assignments with selected expense categories and financial protection measures. Pre-discharge expenditures were significantly higher in public hospitals. The very ill also faced significantly larger expenses, including those for final hospital charges. Hospital-derived discounts provided significantly more support for indigent as well as very sick patients. The amounts for verified PhilHealth claims were significantly greater for the moderately-ill and, incongruously, the financially better-off patients. Sponsored Program members, supposed indigents enjoying fully-subsidized PhilHealth enrollment, qualified for higher mean reimbursements. However, there was a weak correlation between such patients and those identified as poor by the hospital social service staff. Thus, while hospital discounts, subsidies for practical purposes, and PhilHealth reimbursements progressively supported sicker patients, discounts were more responsive in assisting the poor. PhilHealth processes therefore need to be improved so as to more effectively support indigent patients.
本研究旨在从患者的角度出发，评估当地建立的金融保障机制，特别是针对贫困和重病住院患者的效果。数据来自于 2010 年在菲律宾部分省份开展的一项调查，这些省份属于卫生系统发展项目的一部分，涉及 449 名来自选定的私立和公立医院的患者。最初考虑了患者在住院期间产生的直接医疗费用，这些费用要么是在住院前支付，要么是在出院时才开具账单。研究发现，病情较重的患者的费用普遍较高，而贫困患者的费用则较低。本研究评估了医院提供的折扣和社会医疗保险（PhilHealth）报销这两种金融保障机制。平均而言，只有 46%的住院费用可能得到联合金融支持的覆盖。根据医院类型的不同，提交的 PhilHealth 报销申请中有 28-42%被认定为无效。本研究采用多元线性回归分析方法，确定了同一组患者的人口统计学特征、社会经济地位、疾病严重程度和医院分类与选定费用类别和金融保障措施之间的关系。在公立医院，患者在出院前的支出明显更高。病情非常严重的患者还面临着更大的费用，包括最终的医院费用。医院提供的折扣对贫困和重病患者提供了更多的支持。经核实的 PhilHealth 报销金额在病情中等的患者和经济状况较好的患者中显著更高。参与赞助计划的患者，即享受全额补贴的 PhilHealth 参保的贫困人群，有资格获得更高的平均报销额。然而，这些患者与医院社会服务人员认定的贫困患者之间相关性较弱。因此，虽然医院折扣、实际上的补贴以及 PhilHealth 报销逐渐支持病情较重的患者，但折扣更能有效地帮助贫困患者。因此，需要改进 PhilHealth 的报销流程，以更有效地支持贫困患者。
