What is DOTS

1. Factors that affect the access of Philhealth Members on the Philhealth TB DOTS Benefit package: A Qualitative and Quantitative Cross Sectional Study on High and Low Claim Philhealth Accredited DOTS Centers in NCR

2. What is DOTS • TB DOTS • DOTS or Directly Observed Treatment Short course is the internationally recommended strategy for TB control that has been recognized as a highly efficient and cost-effective strategy. DOTS comprises five components: • Sustained political and financial committment. • Diagnosis by quality ensured sputum-smear microscopy • Standardized short-course anti-TB treatment (SCC) given under direct and supportive observation (DOT) • A regular, uninterrupted supply of high quality anti-TB drugs • Standardized recording and reporting Source: http://www.searo.who.int/en/Section10/Section2097/Section2106_10678.htm

3. Problem Statement and Objectives • Statement of the problem • What are the factors that determine accessibility of Philhealth accredited DOTS centers to the Philhealth TB dots benefit package? • Objectives of the paper • To describe factors that influence the access of Philhealth Accredited Centers in Metro Manila to the Philhealth TB DOTS Benefit Package • To evaluate which key areas in the Philhealth accredited DOTS centers may be addressed to improve access

4. Introduction • TB is listed as the 6th leading cause of mortality in the country • The country ranks as the 9th among high burden countries with regards to tuberculosis.

5. The Philippine Health Insurance Corporation or Philhealth has provided packages for its members to avail of the Directly Observed Treatment Short-course (DOTS) treatment since 2004.

6. Phil health TB DOTS Benefit Package • The benefit package provides support for the DOTS facilities in the amount of 4000Php for every Philhealth member that is handled by the Philhealth accredited facility.This includes consultation services, anti-TB drugs, and diagnostic work-ups: 3 sputum examinations and limited use for chest x-rays • Benefit goes towards the center • covers all members of the NHIP and dependents who qualify in the criteria of benefit eligibility which include indigent members. • Claims are released in two phases, first upon completion of requisite forms as proof of the patient’s registry and second, upon submission of formsas evidence of completion of treatment

7. Rationale for the package • Used for the center’s improvement since TB drugs are free due to the global fund for tuberculosis • Can be used by the center depending on the manner by which they choose to allocate these funds • Limited by • Management • LGU- devolution • People operating the facilties

8. Possible factors Identified • Information dissemination • Lack of information on how claims should be filed and processed • Problem in information dissemination from Phil health to PA DOTS facility • Administrative • Applicable to claims • Fear of asking questions (patient to personnel) (personnel to management) • Fear of being embarrassed (document literacy) • Patients not accessing free services (TB-Linc) • Undignified provider service • Poorly motivated, overworked staff • Underpaid staff may mistreat patients

9. Financial • Pilot study performed in the Lung Center of the Philippines • one of the factors indicated was the resources spent when it came to the filing of claims. • includes costs such as photocopying, transportation, time and effort. • As a result, this is considered as a possible barrier to the utilization of the Philhealth TB DOTS Benefit Package • Process • Tedious Process – requirements needed, steps that the center undertakes • Submission of the following forms: • Philhealth TB DOTS Claim form 5 • Philhealth claim form 1 • NTP treatment card • An error with regard to the completion to any of these forms means that it will be returned to the facility for revision