bluuebunny/crossref_metadata_2025_split huggingface dataset:
Addressing Primary Care Inequities in Underserved Areas of the Philippines: A Review
Authors: Naria-Maritana Marianne Joy N. , Borlongan Gabriel R. , Zarsuelo Ma-Ann M. , Buan Ara Karizza G. , Nuestro Frances Karen A. , Dela Rosa Janvic A. , Silva Ma. Esmeralda C. , Mendoza Michael Antonio F. , Estacio Leonardo R. 
Published: December 2020

Background. Inequities in health care exist in the Philippines due to various modifiable and non-modifiable determinants. Through the years, different interventions were undertaken by the government and various stakeholders to address these inequities in primary care. However, inequities still continue to persist. The enactment of the Universal Health Care (UHC) Act aims to ensure that every Filipino will have equitable access to comprehensive and quality health care services by strengthening primary care. As a step towards UHC, the government endeavors to guarantee equity by prioritizing assistance and support to underserved areas in the country. This paper aims to review different interventions to promote equity in the underserved areas that could aid in needs assessment.
Methods. A search through PUBMED and Google Scholar was conducted using the keywords, “inequity,” “primary care” and “Philippines.” The search yielded more than 10,000 articles which were further filtered to publication date, relevance to the topic, and credibility of source. A total of 58 full-text records were included in the review.
Results and Discussion. In the Philippines, inequities in primary care exist in the context of health programs, facilities, human health resources, finances, and training. These were recognized by various stakeholders, from government and private sector, and nongovernment organizations, taking actions to address inequities, applying different strategies and approaches but with a shared goal of improving primary care. On another end, social accountability must also be instilled among Filipinos to address identified social and behavioral barriers in seeking primary care. With political commitment, improvement in primary care towards health equity can be achieved.
Conclusion and Recommendation. To address inequities in primary care, there is a need to ensure adequate human resources for health, facilities, supplies such as medications, vaccination, clean water, and sources of funds. Moreover, regular conduct of training on healthcare services and delivery are needed. These will capacitate health workers and government leaders with continuous advancement in knowledge and skills, to be effective providers of primary care. Institutionalizing advocacy in equity through policies in healthcare provision would help realize the aims of the Universal Health Care Act.
Examining the Oral Health of Filipinos: Policy Analysis
Authors: Mendoza Michael Antonio F. , Zarsuelo Ma-Ann M. , Estacio Jr. Leonardo R. , Silva Ma. Esmeralda C. 
Published: December 2020

Background. High prevalence of oral health problems persists across all age groups among Filipinos despite the continued endeavors of the government and professional societies. This position statement aimed to generate consensus policy recommendations to protect and promote oral health in the Philippines as an integral part of the healthcare service in light of the Universal Health Care (UHC) Act.
Methods. An evidence-based policy brief and presentations of dental and policy experts were used as discussion points in the roundtable discussion conducted by the UP Manila Health Policy Development Hub. Key stakeholders from various sectors were convened to generate inputs for policy actions and amendments to oral health related policies.
Results. Thematic analysis of the discussion was organized using the WHO Building Blocks of Health Systems, which yielded practical, accessible, and population-wide interventions (2010). The following issues were highlighted: (a) health service delivery needs strong collaboration of LGUs; (b) insufficient workforce of dental professionals; (c) market availability of sufficiently fluoridated toothpaste per age group; and (d) health financing scheme on oral health services.
Conclusion and Recommendations. With the shift in the health system landscape brought by the UHC Act, timely and responsive inter-sectoral interventions, focusing on prevention, must be set to attain the target decrease in the prevalence of dental caries. It was also to recommend to (i) engage the academe and training institutions to increase the workforce, (ii) consider adopting international standards on sugar consumption as appropriate, and (iii) ensure sufficient funds for sustainability of oral health programs, particularly school-based caries prevention program starting in pre-schools.
Policy Analysis on Determining Hospital Bed Capacity in Light of Universal Health Care
Authors: Silva Ma. Esmeralda C. , Zarsuelo Ma-Ann M. , Naria-Maritana Marianne Joy N. , Zordilla Zenith D. , Lam Hilton Y. , Mendoza Michael Antonio F. , Buan Ara Karizza G. , Nuestro Frances Karen A. , Dela Rosa Janvic A. , Padilla Carmencita D. 
Published: December 2020

Background. Through the years of improving quality health service delivery, hospital bed capacity in the Philippines has remained to be a persistent challenge. In light of the aim of the Universal Health Care Act to protect and promote the right to health of every Filipino, one metric used to identify areas that are in most need or are under served, is the number of public hospital beds vis a vis the catchment population.
Methods. The systematic review of literature was utilized to generate a policy brief presented to the invited stakeholders of the policy issue for the roundtable discussion participated by all key stakeholders of the policy issue. Evidence and insights were thematically analyzed to generate consensus policy recommendations.
Results. With the current hospital bed availability and maldistribution, the Philippines still faces compounded issues in addressing healthcare demands. Currently, the request for increasing bed capacity is done through legislation. In context, this request is also parallel in expanding service capacity through the allocation of more funds and personnel. The ratio of private and charity beds must ensure to have equity among all patients of varying segments of the population. Enjoining private hospitals to share bed capacity for public service was also explored given appropriate subsidies.
Conclusion and Recommendation. To ensure equity in health service delivery, it is imperative to assess, strategize, and conduct prioritization of the needs of government hospitals for increased bed capacity, considering the distribution, socio-demographic profile, and health needs of the catchment population.
Policy Analysis on Identifying Copayment Services for the Shift in Financing Scheme of Health Care Services
Authors: Lam Hilton Y. , Zarsuelo Ma-Ann M. , Rey Katrina Loren R. , Silva Ma. Esmeralda C. , Mendoza Michael Antonio F. , Padilla Carmencita D. 
Published: December 2020

Background. As the Philippines moves toward universal health coverage, it is imperative to examine how to eliminate inefficiencies, particularly misuse, overutilization, and risks of fraudulent claims. This position statement aimed to identify health services requiring copayments for cost-efficient health financing for the Universal Health Care Act.
Methods. A qualitative study was employed using a systematic review of literature, and thematic analysis of policy roundtable discussion (RTD) was conducted. The systematic review of literature generated evidence for the policy brief and critical points for discussion in the stakeholders’ RTD forum. The RTD was organized by the UP Manila Health Policy Development Hub (UPM HPDH) with the Department of Health (DOH) and was participated by key stakeholders of the policy issue to attain consensus recommendations and develop criteria for identifying services requiring copayments.
Results. An algorithm is proposed by the UPM HPDH based on collective expertise as a guide for policymakers to assess each benefit package in terms of overutilization, the danger of depleting government funds, and the risk of fraud. The use of clinical pathways is suggested to assess the misuse and overutilization of health services. In addition to copayments, benefits packages prone to fraudulent activities should be subjected to fraud prevention processes. Copayment should be linked inversely to the preventability level of the disease or condition.
Conclusion. There were gaps in the current policies to identify services requiring copayment services. Copayment schemes should be carefully determined to prevent misuse, overuse, and fraud of appropriate and necessary health services, while at the same time not limit access to needed care.
Policy Analysis on the Mental Health Needs of Overseas Filipino Workers: Addressing Gaps through Evidence-based Policy Reform
Authors: Silva Ma. Esmeralda C. , Zarsuelo Ma-Ann M. , Zordilla Zenith D. , Estacio Jr. Leonardo R. , Mendoza Michael Antonio F. , Padilla Carmencita D. 
Published: December 2020

Background. There is an increasing number of distressed Overseas Filipino Workers (OFWs) due to adverse working conditions and unresolved post-repatriation issues. The enactment of the Republic Act 11036 (Mental Health Act) in 2018 supports the commitment of the State in promoting and protecting the mental health of every Filipino.
Methods. A systematic review of literature was conducted to generate evidence-based policy tools for the round table discussion conducted by the UP Manila Health Policy Development Hub, engaging all major stakeholders from all sides of the policy issue. Strengths and challenges of the current government initiatives in the phases of predeployment, deployment, repatriation, and reintegration were discussed to attain consensus policy recommendations.
Results. Increased migration led to a cascade of distressed OFWs and their subsequent need for trained mental health professionals. In host countries, challenges in on-site services include (i) limited psychiatry practice as prescribed by law of the host countries, (ii) reciprocity of the host country in allowing more welfare officers, and (iii) budget to support more plantilla items of Assistance to Nationals (ATN) staff. The inter-agency collaboration and legal support for all phases of migration should be holistic and set.
Conclusions and Recommendations. From the literature review and policy discussion, consensus recommendations included strengthening pre-deployment preparation, curbing the trafficking of minors, improving psychiatry practice through the Bilateral Labor Agreement, developing psychosocial counseling competencies among front line host country personnel, enhancing telecounselling services and exploring telemedicine, among others.
Rationalizing Health Personnel Financing Schemes for Evidence-informed Policy Reforms: Policy Analysis
Authors: Lam Hilton Y. , Rey Katrina Loren R. , Zarsuelo Ma-Ann M. , Silva Ma. Esmeralda C. , Mendoza Michael Antonio F. , Padilla Carmencita D. 
Published: December 2020

Background. The Universal Health Care Law seeks to optimize financing of personnel costs without compromising quality and equitable health care among the health care facilities. This position statement aimed to identify strategies and policy recommendations for the cost-effective financing of health personnel in public healthcare facilities.
Methods. A systematic review of literature was done to generate policy brief and key points for roundtable discussion in collaboration with the Department of Health (DOH). The discussion was guided by the three health financing options of DOH: (a) retain Personnel Services (PS) as DOH budget but shift Maintenance and Other Operating Expenses (MOOE) to PhilHealth; (b) shift PS and MOOE to PhilHealth, and (c) rationalize part-time status in government hospitals.
Results. The pros and cons of financing options were cross-examined. In Option 1, physicians in government hospitals would receive fixed salaries from DOH / Local Government Units. In Option 2, there would be a monopsony between PhilHealth and provincial power. Payment will be performance-driven, and balance billing will be eliminated. Option 3 would be a set up of retaining part-time positions for physicians.
Conclusion and Recommendation. Participants deduced that for Option 1, provision of salary augmentation sources and ensuring adequate plantilla items and level of remuneration in government hospitals should be considered, in order to sufficiently compete with physicians’ income from private practice. For Option 2, the PhilHealth reimbursement system should ensure timely reimbursement so as not to subject care providers to financial instabilities. For Option 3, rationalizing part-time status should be flexible and can be applied regardless of how physicians are paid, as this would incentivize caregivers to work harder and smarter.
Return Service Agreement in the Context of the Universal Health Care Act: Using International and Local Experiences to Guide Application of the RSA
Authors: Capeding Theo Prudencio Juhani Z. , Zarsuelo Ma-Ann M. , Mendoza Michael Antonio F. , Estacio Jr. Leonardo R. , Silva Ma. Esmeralda C. 
Published: December 2020

Background. Philippines is in a constant struggle to address shortage and maldistribution of health professionals, affecting equity in service delivery. The government endeavors to generate adequate supply of health workforce through scholarship and training programs which have been further expanded with the enactment of the Universal Health Care (UHC) Act. This article aimed to give a background for discussion on the application of return service agreement (RSA) provisions in the light of attaining universal health care.
Methods. A modified systematic review of literature was conducted guided by the key issues determined by the Department of Health with focus on the extent of scholarship grants and on number of recipients.
Results. The Philippine government enacted policy reforms through implementing RSA in response to the progressive decline of the net flow of health professionals. However, the criticisms lie in that RSA is not a long-term solution. With the RSA provisions in the UHC Law, metrics on determining the under-produced and maldistributed professional cadre must be created. These should be responsive in addressing facility-level and health system-level gaps.
Conclusion and Recommendation. Paucity of current local literature impedes attaining a conclusive body of evidence, therefore, further research is needed. Operationalization of RSA should not be viewed as a singular means to solve the health workforce gaps, but as part of holistic assessment, taking into consideration epidemiological, geographical, political, and social determinants. Stakeholders must ingress in collaborative intersectoral policy actions to warrant bottom-up support. Activities related to mapping, monitoring, and incentivizing medical and health-related professionals must be established to support a system conducive for workforce retention.
Towards Universal Quality Health Care through an Independent Accreditation Agency: A Review
Authors: Borlongan Gabriel R. , Zarsuelo Ma-Ann M. , Mendoza Michael Antonio F. , Silva Ma. Esmeralda C. , Estacio Jr. Leonardo R. 
Published: December 2020

Background. Guaranteeing quality of health care services is part of the objectives of Republic Act No. 11223 or the Universal Health Care (UHC) Act of 2019. In assuring that quality services are delivered by health care providers, they must be accredited to participate in the National Health Insurance Program. The UHC Act mandates the Philippine Health Insurance Corporation (PhilHealth) to recognize third party mechanisms as basis of granting incentives for health facilities that deliver services of higher quality. This review aimed to identify lessons and experiences from literature that can be adopted and contextualized in the Philippine setting, for strategic policies on strengthening the national health facility accreditation system.
Methods. A systematic review of literature was conducted to generate evidence-based recommendations from discussions on cross country experiences and local government initiatives towards improved accreditation system.
Results. By virtue of the UHC Act, a form of strategic purchasing is further institutionalized through a rating system that incentivizes health facilities that provide better services in terms of quality, efficiency, and equity. It is imperative to consider the country’s previous and current gaps and challenges in accreditation and adopt the best practices of other countries, as appropriate to Philippine's local settings. A tool is proposed in creating a national hospital accreditation system using the domains of leadership and governance, financing and sustainability, standards development, program management, and continuing quality improvement.
Conclusion and Recommendations. With the legitimacy of third party accreditation body mandated by the UHC Act, operationalization of the prescribed mechanisms and organizational structure must enjoin all pertinent stakeholders and be supported by sustainable funds and technical assistance by the government.
Identifying Possible Gaps and Gray Areas in the Draft Universal Health Care Act Implementing Rules and Regulations: a Thematic Analysis of a Roundtable Event on Local Health Systems
Authors: Capeding Theo Prudencio Juhani Z. , Zarsuelo Ma-Ann M. , Mendoza Michael Antonio F. , Silva Ma. Esmeralda C. , Estacio Jr. Leonardo R. 
Published: December 2020

Background. The Universal Health Care (UHC) Act is a landmark legislation that seeks to improve provision ofcomprehensive health services through the integration of local health systems. The Department of Health (DOH)conducted a series of roundtable discussions to gather stakeholders' inputs and concerns to refine the initial draftof the Implementing Rules and Regulations (IRR) of UHC.
Methods. On April 4, 2019, the Department of Health led a roundtable discussion on the Local Health Systemssections of the UHC IRR in collaboration with University of the Philippines Manila. A total of 65 stakeholders fromdifferent sectors participated in a semi-structured roundtable event. The proceedings were audio recorded andtranscribed. A thematic analysis was done using NVivo 12 software to document gaps and gray areas identifiedby the participants.
Results. Concerns of the participants revolved around the following: role of the private sector in local health systems;the integration of different municipal and other component health systems into a province-wide health system;organizational design of the health systems; pooling and utilization of the Special Health Fund (SHF). Gaps andgray areas were concentrated on the transfer of personnel and other health resources to the province-wide system,the composition of the Provincial Health Board, and the utilization and management of the SHF.
Conclusion. The roundtable event acquired various perspectives from stakeholders that could help the DOH identifypriority action points that could be resolved at the agency level. The identified themes from the study analysis couldbe of value to decision makers to clarify issues, address policy gaps, and to prioritize future research directions.
Menopause Related Health Problems and Quality of Life of Menopausal Women from Urban Slums of Western Maharashtra: An Observational Study
Authors: Anandkumar Vahini , Kotnis Shubhalaxmi D 
Published: December 2020

Introduction: During menopause, women may experience vasomotor, psychosocial, physical, as well as sexual dysfunction. Studies on menopausal issues and health demand priority in the Indian scenario due to the growing population of menopausal women as a result of their increased life expectancy.
Materials& Methods: A cross-sectional study was conducted using a predesigned, structured questionnaire based on socio-demographic variables and menopausal symptoms as per the MEN-QOL questionnaire and administered by the investigator. Postmenopausal women coming to UHTC were selected purposively until the sample size was reached and interviewed. Data collected were coded and entered in an Excel sheet. Values were expressed in the form of frequency and percentages.
Results: The mean age at menopause was 48.8 years. Most frequent menopausal symptoms were aching in muscle and joints (72.9%), feeling tired (65%), poor memory (61.4%), lower backache (49%), and difficulty in sleeping (54.3%). The vasomotor and sexual domains complained when compared to physical and psychological domains.
Conclusion: The age at onset of menopause in an urban area of southwestern Maharashtra is 48.8 years which is four years more than the mean menopause age for Indian women. The most frequent menopausal symptoms were aching in muscle and joints, feeling tired and poor memory.
Economic impact of environmental efficiency on sales price and used transaction price of apartment buildings empirical analysis using the assessment data of CASBEE Yokohama
Authors: Takada Hideyuki , Yoshida Yoshikuni , Kawakubo Shun , Yamaguchi Ayuta 
Published: December 2020

AbstractThe aim of this study is to analyze the effects of environmental efficiency of buildings on real estate prices. Therefore, based on the Comprehensive Assessment System for Built Environment Efficiency (CASBEE) of the local government, we investigated 485 apartment buildings assessed by CASBEE Yokohama. The analysis results revealed the following three points:

When the Built Environment Efficiency (BEE) value increased by one point, the average unit price increased by 5.5%.
A one‐point increase in the BEE value has a positive impact of 1.63% on the annual rate of change of used transaction price.
It is economically advantageous to purchase an apartment building with a high BEE value when considering future sales.
Predictors of Unsuccessful Hydroxychloroquine Tapering and Discontinuation: Can We Personalize Decision‐Making in Systemic Lupus Erythematosus Treatment?
Authors: Almeida‐Brasil Celline C. , Pineau Christian A. , Vinet Evelyne , Hanly John G. , Peschken Christine A. , Clarke Ann E. , Fortin Paul R. , Abrahamowicz Michal , Bernatsky Sasha 
Published: December 2020

ObjectiveHydroxychloroquine (HCQ) is a key systemic lupus erythematosus (SLE) drug, making concerns of drug shortages grave. Our objective was to evaluate factors associated with poor outcomes after HCQ taper or discontinuation in SLE.MethodsWe studied 5 Canadian SLE cohorts between 1999 and 2019, following patients from the date of HCQ tapering (cohort 1) or discontinuation (cohort 2). A composite outcome was defined as any of the following: a need for therapy augmentation, an increase (of at least 4 points) in the Systemic Lupus Erythematosus Disease Activity Index 2000 score, or hospitalization for SLE. In each cohort, multivariable Cox regression was used to identify demographic and clinical factors associated with time to the earliest of these events. A third cohort continuing to receive HCQ was also studied, to assess whether the same factors influenced the outcome even when the HCQ dose was unchanged.ResultsThe poor outcome rate, per 100 person‐years, was 35.7 (95% confidence interval [95% CI] 31.6–40.3) in the HCQ taper cohort (n = 398), 29.0 (95% CI 25.5–33.0) in the discontinuation cohort (n = 395), and 16.1 (95% CI 13.2–19.6) in the maintenance cohort (n = 395). In patients tapering HCQ, baseline prednisone use was independently associated with greater risk of poor outcomes. In the discontinuation cohort, the risk of poor outcomes was greater for Black patients and those diagnosed with SLE at age ≤25 years. Among those maintaining HCQ, baseline immunosuppressive use and First Nations ethnicity were associated with poor outcomes.ConclusionWe identified demographic and clinical factors associated with poor outcomes after HCQ taper/discontinuation. This information is critical in the current setting of potential shortages, but over the long term, such information could inform personalized therapies.