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Methodology

Methodology. Qualitative and quantitative Desk review Key informant interviews ( PhilHealth , CHO) Combined survey and interview for health centers Survey – quantitative Interview – qualitative. Study Design. Cross-sectional study

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Methodology

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  1. Methodology • Qualitative and quantitative • Desk review • Key informant interviews (PhilHealth, CHO) • Combined survey and interview for health centers • Survey – quantitative • Interview – qualitative

  2. Study Design • Cross-sectional study • Sample population: 64 PhilHealth accredited health centers as of May 2009 • Interviewed health center staff involved in handling claims for PhilHealth TB DOTS package MARS: Sample size nalang and stat tests kulang

  3. Issue of non-claiming • Defined non-claiming – those who have not completed whole process of claiming* • Real Status: • Never claimed • Claimed at one point but ceased • Will claim eventually

  4. Why non-claiming? • Low membership encounter • No ordinances/agreements for allocation • Loss of interest • Lack of incentives • Heavy workload • Undermanned workforce

  5. Why non-claiming? • Discouraged due to failed and rejected claims • Very complicated claiming process • Need for a more complete and detailed guidelines for claiming • Lack of information (lack of orientation)

  6. Information Dissemination: PHILHEALTH • Training • Available: CHO dependent • Adequate but lacks: • Complete guidelines • Required documents • Reimbursement and encashment • Process still confusing • Direct communication • CHO • Calling directly (C) • Accreditation Status Check • None (NC)

  7. Information Dissemination: Within Centers • Meetings, lectures or none • Orient others – none • Information is not transferred or cannot be transferred • Knowledge of benefit of claiming is present but is mostly not felt

  8. Information Dissemination:With Patients • Patients encouraged through the ff: • Giving purpose and benefit of package (C) • Asking if PhilHealth member (reminder) then encouraged to submit (C) • Encourage non-members to become members (NC) • Do not encourage (NC) • Patient problems include • Documents • Lack of time/money • Complicated • Employee problems

  9. Center Administration • Assisting patients through explaining processes, explaining document fields and reminding deadlines (significant) • Protocols such as need to assist patients, checking completeness of documents and fixing claims as part of job description (not significant) • No incentives (significant) and heavy workload proved to be major discouragement in claiming

  10. Center Administration *Limitation of Center Administration: lack of PhilHealth members

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