ABSTRACT

OVILLA, MARIBEL O., THE NATIONAL QUALITY ASSURANCE PROGRAM (NQAP) OF THE PHILHEALTH AMONG TERTIARY HOSPITALS IN THE PROVINCE OF ALBAY (Unpublished Dissertation, Aquinas University of Legazpi Professional School, Legazpi City, April 2007.)

This study aimed to determine the implementation of the National Quality Assurance Program of the Philippine Health Insurance Corporation and propose strategies to enhance the program. To address this main problem, the following sub-problems were identified: (1) What is the status of implementation of the National Quality Assurance Program (NQAP) of the Philhealth in the province of Albay along: personnel, records management, and service capability?; (2) What is the level of satisfaction of the Philhealth members and/ or immediate family members on the quality of services provided by accredited health care providers in the Province of Albay?; (3) What are the problems encountered in the implementation of the national Quality Assurance Program (NQAP) of the Philhealth in the province of Albay as rated by Phil health members/ dependents and implementers?; (4) What measures have been adopted to address the problems; and (5) What Strategies may be developed to enhance the implementation of the National Quality Assurance Program of the Phil Health in the province of Albay?

This study was a descriptive type of research utilizing questionnaire in gathering the data on the implementation of NQAP in the province. A total of 738 respondents were involved in this study comprising of 515 respondents from private hospitals and 223 from government hospital-the Bicol Regional Training and Teaching Hospital (BRTTH).

The statistical tools used were frequently count, weighted arithmetic mean and rank.

On the basis of the data presented in chapter 4, the following were found: Private hospitals had more personnel (i.e, medical staff, nurses and nursing aides/midwives) than government hospitals in the province. The study also revealed that government and private hospitals in the province of albay complied with the requirements set by Phil Health accreditation insofar as records management is concerned. Logbooks, clinical charts and reference books were all available. Similarly, the National Quality Assurance program along service capability were generally implemented particularly along pediatric service, OB Gynecology service, emergency and outpatient service, intensive care service, rehabilitation service, ancillary service and dietary service.However,some wards/services do not have medicines and medical supplies. All intensive Care Service of private and government hospitals were not isolated in the ward. Occupational therapist was not available in government and private in the province.

Phil Health members and their dependents were moderately satisfied with the quality of services provided by private and government hospitals in the province as indicated in the general weighted average of 3.30 and 3.33. Surgical had the highest level of satisfaction fallowed by OB-Gyne service both for private and government hospitals.

Phil Health members and their dependents were least satisfied with the services rendered by nursing ward for private hospitals and rehabilitation medicine ward for government hospitals. Phil Health members and their dependents encountered problems among private hospitals in the province on the following: a)lack of infant cribs, poor sanitation and absence of pediatrician for pediatric ward; b)inadequate bed,bed sheets and pillow cases, and dirty comfort rooms for OB-Gyne ward.; c) Lack of emergency medicine for emergency and out -patient ward; d)unclean surroundings and irregular water supply for intensive care services; e) lack of surgical supplies and lack of anesthesiologist on duty for surgical ward; f)expensive therapy services for rehabilitation and medicine services; g) lack of orientation on hospital facilities and room of choice and beds are not well-kept for nursing service; h) lack of medicines in the pharmacy for ancillary service; and , i) lack of water supply and lack of potable water for dietary service.

The implementer encountered problems on lack of licensed nurses to maintain Phil Health accreditation of hospital beds; presence of unlicensed doctors on duty; late submission of Monthly Mandatory Hospital Report (MMHR); expired licenses of hospital to operate; lack of blood pressure apparatus; lack of beds and side rails; dirty comfort rooms, lack of water supply in the toilet and two (2) beds occupied by three patients; lack of emergency medicine, ambulance and nurse on duty; lack of intensivist and utilizing one doctor on duty for ICU and ER; lack of surgeon, anesthesiologist, and non-functional autoclave; lack of occupational therapist on duty; nurse’s notes done by midwives on duty; lack of pharmacist on duty; and lack of nutritionist-dietitian on duty.

To address the problems encountered by the Phil Health implementer, the following measures have been adopted: strict monitoring on the compliance to the required number of personnel; monitoring procedure that has developed was implemented guidelines on MMHR submissions has been implemented; and, informal dialogue with the accredited hospitals has been implemented.

There were strategies developed to enhance the implementation of the National Quality Assurance of Philippine Health Insurance Corporation which include: Strict adherence to Phil health accreditation requirement, outsourcing of specialist in hospitals, enforcement of policy requiring licensed doctors to supervise internist, intensive review of evaluation instruments and expedite on-time submission of reports through strict implementation of policies.

The study concluded that: A typical private tertiary hospital has more personnel (i.e., medical staff, nurses, nursing aides, midwives); has complied with requirements set by Phil health (although medicines may not be available most of the time); and implements the different hospital service. A government hospital does not have enough personnel, has complied worth the requirements set by Phil health and implements the different hospital services; (2) The Phil health members and/ or dependents were moderately satisfied with the services provided by tertiary hospitals indicating a 41%-60% level of satisfaction; (3) Hospital have varied problems ranging from problems on the process and procedures, location of the accredited hospitals, services and supply of necessary materials and equipment in their operation; lack of licensed nurses to maintain Phil health accreditation of hospital beds; presence of unlicensed doctors on-duty; late submission of Monthly Mandatory Hospital Report (MMHR);expired licenses of hospital to operate; lack of blood pressure apparatus; lack of beds and side rails; dirty comfort rooms, lack of water supply in the toilet and two (2)beds occupied by three patients; lack of emergency medicine ambulance and nurse on duty; lack of intensivist and utilizing one doctor on duty for ICU and ER;lack of surgeon,anestheosiologist, and non functional autoclave; lack of occupational therapist on duty: nurse’s notes done by midwives on duty; (4)Philhealth implementers had adopted measures to address the problems encountered these include: Strict monitoring on the compliance to the required number of personnel. Monitoring procedure that has been developed was implemented. Guidelines on MMHR submission have been implemented. Informal dialogue with the accredited hospitals have been implemented; (5) Strategies were identified/ developed based from the problems to enhance the implementation of the National Quality Assurance of Philippine Health Insurance Corporation which include: Strict adherence to Phil health accreditation requirement, Out-sourcing of specialist in hospitals, enforcement of policy requiring licensed doctors to supervise internist, intensive review of evaluation instrument, commission some agencies/ entitles to conduct inspection of hospitals, expedite on-time submission of reports through strict implementation of policies.

On the basis of the findings of the study and the conclusion drawn, the following recommendations were offered for the enhancement of the National Quality Assurance Program (NQAP) of Philippine Health Insurance Corporation.

1. A further review of the proportional; allocation of personnel must be made to meet future demands. A thorough evaluation procedure should be strengthened to address possible increase in non-compliance especially on failure to hire licensed allied health personnel. Services must be thoroughly evaluated to avoid possible problems in accreditation.
2. Private and government hospitals should further improve their services to the clients in order to increase the level of satisfaction of Phil health members. This could be made possible through upgrading of their facilities and equipment. Similarly, additional doctors, nurses and other medical personnel must be employed to cope with the requirements of Phil health Circular No.35 s.2006.
3. Periodic monitoring and evaluation procedures and constant dialogue with accredited hospitals should be maintained so that problems may be avoided if not lessened.
4. Intensify measures adopted since they have addressed the problems encountered in the implementation.
5. Implement the strategies developed in this in this study to enhance the implementation of the National Quality Assurance program.
6. Conduct study along Monitoring and Evaluation.
7. Conduct study on the impact of accreditation to hospitals and their effects to members.
8. Conduct perception study on the services rendered by accredited hospitals.