Geographic variations in health care utilization under the National health insurance program of the Philippines

Abstract

Geographic variations in health care utilization are increasingly being reported in various countries spurring interest and concern among health professionals, academicians and health policy makers alike. This study explored variation in health care utilization in the Philippines under the country's current social health insurance scheme using the claims data for the year 2003. Health care utilizaiton was measured in three ways-admission rate, reimbursement and length of stay. In order to control for variation caused by disease patterns only pneumonia cases were analyzed. Analysis was done in different levels of aggregation whenever the data permitted. Results showed significant variation in all three measures of utilization. Admission rates were observed higher in the more rural and/ or regions with higher poverty incidence rates but do not seem to be correlated with morbidity. The major factors influencing reimbursement and length of stay, across the different levels of aggregation, were similar but to varying extent. These were the setting of care (type and category of hospital) and severity of case. However, considerable variation, especially in length of stay cannot be accounted for by these factors making physician practice patterns a likely factor for variation. A number of recommendations were discussed in order to reduce variation. Further investigation was likewise proposed for regions with disproportionately high admission rates as it might imply less access to preventive care and less knowledge on health care issues.