菲律宾城市、农村和偏远地区初级保健福利对医疗保健利用及估计自付费用的影响。
Impact of primary care benefits on healthcare utilisation and estimated out-of-pocket expenses in urban, rural and remote settings in the Philippines.
作者信息
Panganiban Janelle Micaela S, Camiling-Alfonso Romelei, Sanchez Josephine T, De Mesa Regine Ynez H, Sandigan Gillian, Amit Arianna Maever L, Rey Mia P, Lopez Johanna Faye E, Fabian Noleen Marie, Galingana Cara Lois T, Bernal-Sundiang Nannette, Aquino Maria Rhodora N, Lastrilla Chad Lester, Callo Miguel, Tan-Lim Carol Stephanie Chua, Dans Leonila F, Marfori Jose Rafael A, Paterno Ramon Pedro, Dans Antonio L
机构信息
Program on Health Systems Development - Philippine Primary Care Studies, Center for Integrative and Development Studies, University of the Philippines Diliman, Quezon City, Philippines.
National Clinical Trials and Translation Center, National Institutes of Health, University of the Philippines Manila, Manila, Philippines.
出版信息
BMJ Open Qual. 2025 Jan 22;14(1):e002676. doi: 10.1136/bmjoq-2023-002676.
BACKGROUND
This study aimed to determine the effects of primary care interventions on healthcare utilisation and estimated out-of-pocket (OOP) expenses in selected urban, rural and remote settings in the Philippines.
METHODOLOGY
Context-specific measures relating to expanding healthcare provider networks, augmenting the health human workforce and subsidising transportation costs were implemented to strengthen primary care systems. In this study, two key outcomes were monitored: (1) monthly healthcare utilisation measured by the total number of outpatient consultations per site and (2) change in OOP expenses from baseline to endline within a 1 year study period.
RESULTS
All sites had a positive trend in monthly outpatient consultations in healthcare utilisation over 1 year. The remote site had the steepest increase in outpatient consultations, with a 401% increase compared with the baseline during the peak of consultations at month 7. The urban site had a 62% increase in outpatient consultations from baseline to month 6, while the rural site had a 251% increase from baseline to month 11, which corresponded to the peak month in terms of the number of outpatient consultations. The rural site had the largest decrease in estimated OOP expenses (50.3% reduction, 95% CI -88 to -13), followed by the remote site (33.2% reduction, 95% CI -67,+1) and the urban site (16.0% reduction, 95% CI -65,+33).
CONCLUSION
The rural site showed a significant reduction in estimated OOP expenses and an increase in healthcare utilisation. The remote site had the steepest increase in utilisation, but the reduction in estimated OOP expenses was not statistically significant. The urban site experienced the lowest increase in utilisation, and the smallest reduction in estimated OOP expenses, which was also not statistically significant. Implementing primary care benefits will necessitate contextualised approaches to avoid the inadvertent aggravation of inequities in healthcare.
背景
本研究旨在确定菲律宾部分城市、农村和偏远地区的初级保健干预措施对医疗保健利用情况和估计自付费用的影响。
方法
实施了与扩大医疗服务提供者网络、增加卫生人力以及补贴交通费用相关的因地制宜措施，以加强初级保健系统。在本研究中，监测了两个关键结果：（1）以每个地点的门诊咨询总数衡量的每月医疗保健利用情况，以及（2）在为期1年的研究期内，自付费用从基线到终线的变化。
结果
在1年多的时间里，所有地点的医疗保健利用方面的每月门诊咨询都呈积极趋势。偏远地区门诊咨询的增幅最大，在第7个月咨询高峰时，与基线相比增加了401%。城市地区门诊咨询从基线到第6个月增加了62%，而农村地区从基线到第11个月增加了251%，这与门诊咨询数量的高峰月份相对应。农村地区估计的自付费用下降幅度最大（减少50.3%，95%置信区间-88至-13），其次是偏远地区（减少33.2%，95%置信区间-67，+1）和城市地区（减少16.0%，95%置信区间-65，+33）。
结论
农村地区估计的自付费用显著降低，医疗保健利用率提高。偏远地区利用率增幅最大，但估计的自付费用减少在统计学上不显著。城市地区利用率增幅最低，估计的自付费用减少幅度最小，且在统计学上也不显著。实施初级保健福利将需要因地制宜的方法，以避免无意中加剧医疗保健方面的不平等。
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