Challenges and Experiences in the Referral System Under the Anti-Hospital Deposit Law (RA 8344): A Qualitative Study Among Stakeholders in Maasim, Sarangani Province

Abstract

The effective implementation of the Anti-Hospital Deposit Law (Republic Act No. 8344, as amended by Republic Act No. 10932) is essential in ensuring timely access to emergency healthcare services without requiring financial deposits before treatment or referral. Despite the legal mandate, challenges continue to affect the efficiency of patient referrals, particularly in geographically isolated communities. This qualitative descriptive-interpretive study explored the challenges and experiences of stakeholders involved in the patient referral system in Maasim, Sarangani Province. Specifically, the study sought to identify the operational and systemic barriers affecting patient transfers between public and private healthcare facilities and to develop a strategic plan to improve compliance with the law. Purposive sampling was employed to select key informants, including hospital administrators, frontline healthcare workers, local government unit (LGU) health officials, and patients or their relatives. Data were collected through semi-structured, in-depth interviews and analyzed using thematic analysis guided by Institutional Theory. The findings revealed several recurring themes affecting the referral process, including financial constraints, limited bed capacity, inadequate transportation resources, communication and coordination issues among healthcare facilities, workforce shortages, and delays in referral acceptance. Participants also emphasized the need for standardized referral protocols, continuous staff training, stronger inter-agency collaboration, improved reimbursement mechanisms, and the adoption of digital referral systems to enhance service delivery. The study concludes that while healthcare providers remain committed to complying with the Anti-Hospital Deposit Law, organizational, financial, and logistical barriers continue to impede its effective implementation. Strengthening collaboration among healthcare institutions, improving resource allocation, enhancing communication systems, and implementing sustainable policy reforms are essential to achieving an efficient, patient-centered referral system. The proposed strategic plan provides practical recommendations that may assist local government units, hospital administrators, and policymakers in improving referral services and ensuring equitable access to emergency healthcare in Maasim, Sarangani Province.