Utilization of the PhilHealth Konsulta Package in Level II Private Hospital in Arayat, Pampanga: A Basis for Operational Development Plan
DOI:
https://doi.org/10.5281/zenodo.21522697Keywords:
PhilHealth Konsulta Package, primary health care, healthcare utilization, private hospital, operational development, Universal Health CareAbstract
This study assessed the utilization of the PhilHealth Konsultasyong Sulit at Tama (Konsulta) Package in a Level II private hospital in Arayat, Pampanga and developed an operational development plan to improve patient participation and service delivery. A quantitative descriptive design was used, integrating patient and healthcare-provider surveys with hospital utilization and reimbursement records for 2023–2024. The participants were 371 registered patient-beneficiaries selected through proportionate stratified random sampling and 10 personnel directly involved in Konsulta implementation who were included through total enumeration. Data were analyzed using frequency, percentage, weighted mean, standard deviation, and chi-square tests at the .05 level. All patient respondents were registered under Konsulta; however, utilization was moderate, with annual use being most common (28.8%). Health screening (90.3%) and consultation (81.9%) were the most frequently availed services, whereas laboratory tests (51.2%) and medicines (37.7%) were used less often. Annual reimbursements increased from ₱550,662 in 2023 to ₱3,771,157.60 in 2024. Patient awareness (M = 2.84) and accessibility (M = 3.01) were neutral. Major patient barriers were limited services (21.3%), lack of awareness (21.0%), long waiting time (19.4%), and lack of medicines (19.1%). Providers rated workflow and facilities positively but identified inadequate manpower (M = 2.40); system delays (100%), manpower shortages (90%), and patient awareness (70%) were the leading operational challenges. Age was significantly related to utilization (χ² = 9.654, p = .021), while sex was not (χ² = 1.234, p = .462). The findings show that registration and growing reimbursement do not automatically produce sustained utilization. The proposed plan therefore prioritizes patient education, staffing, workflow redesign, medicine and service availability, access assistance, and monitoring of claims and patient experience.
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References
Adam, T., & de Savigny, D. (2012). Systems thinking for strengthening health systems in LMICs: Need for a paradigm shift. Health Policy and Planning, 27(Suppl. 4), iv1–iv3. https://doi.org/10.1093/heapol/czs084
Creswell, J. W., & Creswell, J. D. (2018). Research design: Qualitative, quantitative, and mixed methods approaches (5th ed.). SAGE Publications.
Cu, A., Meister, S., Lefebvre, B., & Ridde, V. (2021). Assessing healthcare access using the Levesque conceptual framework: A scoping review. International Journal for Equity in Health, 20, 116. https://doi.org/10.1186/s12939-021-01416-3
Dans, L. F., Marfori, J. R. A., De Mesa, R. Y. H., Galingana, C. L. T., Fabian, N. M. C., Rey, M. P., Sanchez, J. T., Catabui, J. T., Sundiang, N. B., Paterno, R. P. P., Co, E. E. A., Tan-Lim, C. S. C., & Dans, A. A. M. L. (2024). Health benefit utilization and out-of-pocket expenses in outpatient care and hospitalizations: Baseline surveys of three primary care sites in the Philippines. Acta Medica Philippina, 58(16), 133–140. https://doi.org/10.47895/amp.vi0.7453
Dayrit, M. M., Lagrada, L. P., Picazo, O. F., Pons, M. C., & Villaverde, M. C. (2018). The Philippines health system review. World Health Organization Regional Office for the Western Pacific.
Department of Health. (2019). Implementing rules and regulations of the Universal Health Care Act. https://doh.gov.ph/UHC-IRR
GBD 2019 Healthcare Access and Quality Collaborators. (2022). Assessing performance of the Healthcare Access and Quality Index, overall and by select age groups, for 204 countries and territories, 1990–2019: A systematic analysis from the Global Burden of Disease Study 2019. The Lancet Global Health, 10(12), e1715–e1743. https://doi.org/10.1016/S2214-109X(22)00429-6
Haw, N. J. L., Uy, J., & Ho, B. L. (2020). Association of social health insurance coverage and level of healthcare utilization and costs in the Philippines: A 10-year pooled analysis. Journal of Public Health, 42(4), e496–e505. https://doi.org/10.1093/pubmed/fdz142
Jaminola, L. I., Negre, J. M., Pepito, V. C. F., Loreche, A. M., & Dayrit, M. M. (2023). The policy environment of self-care: A case study of the Philippines. Health Policy and Planning, 38(2), 205–217. https://doi.org/10.1093/heapol/czac095
Lavado, R. F., Brooks, B. P., Hanlon, M., & Pantig, I. M. (2018). Barriers to health care access in the Philippines: A review of recent studies. Philippine Institute for Development Studies.
Levesque, J.-F., Harris, M. F., & Russell, G. (2013). Patient-centred access to health care: Conceptualising access at the interface of health systems and populations. International Journal for Equity in Health, 12, 18. https://doi.org/10.1186/1475-9276-12-18
Pelayo, G. M., Dela Cruz, T. T., Israel, I. C. D., Jacinto, M. A., & Balaria, F. E. (2025). Evaluation of PhilHealth Konsulta program implementation: Perspective of selected accredited Konsulta providers in Nueva Ecija. International Journal of Advanced Engineering, Management and Science, 11(1), 20–26. https://doi.org/10.22161/ijaems.111.3
Philippine Health Insurance Corporation. (2020). Governing policies of the PhilHealth Konsultasyong Sulit at Tama (Konsulta) Package: Expansion of the primary care benefit to cover all Filipinos (PhilHealth Circular No. 2020-0002). https://www.philhealth.gov.ph
Philippine Health Insurance Corporation. (2021). PhilHealth Konsulta: Konsultasyong Sulit at Tama. https://www.philhealth.gov.ph/konsulta/
Philippine Health Insurance Corporation. (2024a). Rules on the PhilHealth Konsulta Package (PhilHealth Circular No. 2024-0001). https://www.philhealth.gov.ph
Philippine Health Insurance Corporation. (2024b). PhilHealth releases ₱257.6 million to boost primary care service delivery through Konsulta. https://www.philhealth.gov.ph/news/up/article/2024/news_66114837e9b94.php
Republic Act No. 11223. (2019). Universal Health Care Act. Official Gazette of the Republic of the Philippines. https://www.officialgazette.gov.ph/2019/02/20/republic-act-no-11223/
Rey, M. P., De Mesa, R. Y. H., Marfori, J. R. A., Fabian, N. M. C., Camiling-Alfonso, R., Paterno, R. P. P., Sundiang, N. B., Yusoph, A. B., Dans, L. F., Galingana, C. L. T., Aquino, M. R. N., Sanchez, J. T., Catabui, J. T., & Dans, A. M. L. (2024). The cost of primary care: An experience analysis in an urban setting. Acta Medica Philippina, 58(23), 7–18. https://doi.org/10.47895/amp.vi0.6589
Siddiqi, S., Aftab, W., Venkat Raman, A., Soucat, A., & Alwan, A. (2023). The role of the private sector in delivering essential packages of health services: Lessons from country experiences. BMJ Global Health, 8(Suppl. 1), e010742. https://doi.org/10.1136/bmjgh-2022-010742
World Health Organization. (2010). Health systems financing: The path to universal coverage. https://www.who.int/whr/2010/en/
World Health Organization. (2018a). A vision for primary health care in the 21st century: Towards universal health coverage and the Sustainable Development Goals.
World Health Organization. (2018b). Universal health coverage. https://www.who.int/news-room/fact-sheets/detail/universal-health-coverage-(uhc)
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