Utilization of Universal Health Care Coverage in the Outpatient Consultation in a Level II Health Facility in East Pampanga: A Basis for Operational Development Framework

Abstract

This study examined the utilization of Universal Health Care (UHC) coverage for outpatient consultations in a Level II health facility in East Pampanga and used the findings as the basis for an Operational Development Framework. A quantitative, retrospective design was employed using all available facility records of UHC outpatient patients from 2023 to 2024. Data were extracted from hospital records and analyzed through frequencies, percentages, trend comparison, and financial analysis using SPSS. The findings showed that adults constituted the largest group of service users, with 1,989 patients or 62.51%, followed by senior citizens with 808 or 25.39% and minors with 414 or 13.01%. Male patients accounted for 55.69% of utilization, while female patients comprised 44.31%. First consultations were considerably more frequent than follow-up consultations, with 2,488 and 694 cases, respectively. UHC reimbursements increased from ₱550,660 in 2023 to ₱3,771,160 in 2024, resulting in a total reimbursement of ₱4,321,820. The findings indicate broad utilization of UHC outpatient services and increasing financial support for their implementation; however, incomplete patient records limited the analysis of several intended variables. The study concludes that improved health information systems, patient-centered services, continuity-of-care mechanisms, barangay coordination, claims management, and strategic budget allocation are necessary to enhance the accessibility, efficiency, and financial sustainability of UHC outpatient services.