Impact of Primary Care Benefits on Outpatient Health Care Utilization and Estimated Out-of-Pocket Expenses: A Follow-up Pre-post Study of Three Primary Care Sites in the Philippines

Abstract

Background Health inequity is a prevailing issue in the Philippines. Universal health care (UHC) aims to provide equitable access to healthcare services and protection from financial risk for all Filipinos. The Philippine Primary Care Studies (PPCS) evaluated the impact of interventions to improve primary care in an urban, rural, and remote area in the country, which represented communities with higher, lower, and least baseline resources for health care, respectively. We previously measured healthcare utilization and change in out-of-pocket (OOP) expenses for outpatient services from baseline to one year after implementation of interventions. Objective This is a follow-up study that measured the same outcomes until funding for the interventions was depleted. Methods The interventions to strengthen the primary care system included equal per capita health financing in all three areas, establishment of an electronic health record system, healthcare worker training, and early community engagement. Other context-specific interventions were also implemented in the rural and remote sites. We evaluated healthcare utilization (measured as the total number of ambulatory consultations per month) and OOP expenses (estimated through community surveys performed at baseline and yearly thereafter). These outcomes were measured at baseline prior to implementation of interventions, during the first year of implementation when full funding was available, in the second year of implementation when partial funding was available, and at the third or fourth year of implementation when funding ended. Results Improvements in primary care had the most impact on the rural site, having the highest number of cumulative ambulatory consults and the lowest out-of-pocket expenses per study year. It had the least impact on the urban site, while the remote site generally had modest improvements. Conclusion Policies and interventions to improve primary care may inadvertently aggravate existing inequities, especially in remote areas. Rather than equal distribution, funding must be allocated according to need, and interventions must be contextualized to local settings, if UHC is to successfully reduce inequities in healthcare access in the country.