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The Cost of Healthcare Identified: Document Analysis between two delivery cases at Private and Public Hospitals in the

Philippines CHAPTER 1 The Problem and Its Background

There is always one question that the health care providers want to know. Should all hospitals be privatized? What differences or comparisons does public and private hospitals have in terms of its cost?

The term health system encompasses the personnel, institutions, commodities, information, financing and governance strategies that support the delivery of prevention and treatment services. The main objectives of a health system are to respond to peoples needs and expectations by providing services in a fair and equitable manner. The World Health Organization defines a health system as all the activities whose primary purpose is to promote, restore, or maintain health.. The World Bank defines health systems more broadly to include factors interrelated to health, such as poverty, education, infrastructure and the broader social and political environment (Global Sysytem Org,2000-2012).

Hospitalization is indeed hard for everyone. The medications, the medical examinations, other procedures to be done, like surgery has an effect to the family, and especially the expenses. One factor that clients consider in seeking medical care is the

cost. Most people doesnt seek medical attention because of this. The researchers chose this as the research topic because they would want to identify the cost differences of Public and Private Hospital specifically by two delivery cases here at Valenzuela City. The goals of this study is to: Identify the cost differences. Give knowledge to the readers or Health Care seekers. Identify the differences of Private and Public Hospitals in terms of settings and in providing health to the clients.

Public or Private Hospitals are health care institutions primarily equipped with one goal which is to serve the people and promote wellness. However, private and public hospitals still has its differences. Public hospitals is supported mainly by the Department of Health, the mission of the department is to provide equitable, sustainable and quality healthcare services for all Filipinos and is mainly financed through taxes, allowing free services to be provided to local citizens; while the Private Hospitals is largely marketoriented and it is financed based on patients paying for the utilized medical services (Healthcare System Information;Globalsurance,2005-2011).

Furthermore, Public hospital sector handles the majority of acute care separations and accounts for most regional and remote hospitals, while private hospitals are more concentrated in metropolitan areas and are more likely to treat patients of higher socioeconomic advantage (Public and Private Hospital;Research Report, Australian Government, 2009).

Filipinos with lower socioeconomic status often times obtain medical services from government operated hospitals because it is less expensive. Despite the fact that it is less expensive and it is sometimes free, public hospital facilities may not be as impressive and technologically or medically advanced with private hospitals. Private hospitals requires down payment before any procedure or during the time of admission and could be very hard for poor Filipinos.

Statement of the Problem The study aims to determine the comparison between two delivery cases at private and public hospitals in the Philippines. Specifically, it seeks to answer the following questions: 1. Is there a positive correlation between the socioeconomic status of the participant and the chosen hospital sector (private/public)? 2. Is there a significant difference between the cost of the participant in the Private Hospital and Public Hospital? 3. What factors does the patient consider in choosing which health care sector to go? Hypothesis of the Study Significance of the Study The outcome of the study will directly and/or indirectly affect the following:

Patients. Healthcare clients, as the primary recipient of nursing care, may benefit through the imparted knowledge of the study, from the identification and comparison of the cost of the two delivery case in Public and Private Hospital.

Nurses. This study will improve their skills and gain more knowledge about the procedures and techniques in the health care setting from the identification and comparison of the cost of the two delivery case in Public and Private Hospital.

Hospital Administrators. Findings from the study may help the hospital administrators to determine which should be changed and improved in the delivery system of the particular sector. This may also improve the quality of health care services they are offering to their clients.

Healthcare Delivery System. Findings from the study may help improve the healthcare delivery system. Identification and comparison of the cost of the two delivery case in Public and Private Hospitals will help to improve the quality of service medical institutions are offering its clientele.

Members of the Healthcare Team. This study may assist other members of the health care team to identify and be aware of the patients situation especially the financial situation of patient. Understanding patients situation is an essential step towards achieving optimum level of care and level of health.

Further Studies. This study may help future researches about Private and Public Hospitals in the Philippines. Findings from the research may present new knowledge among the cost differences between Private and Public Hospital of the two delivery cases and may progress health care delivery system in the country.

Scope and Limitation of the Study The study focuses on document analysis of the cost between two delivery cases at Private and Public hospital in the Philippines. The study will be conducted at two selected houseof the respondents. The timeframe of the study is from June to July 2012.

CHAPTER 2 Review of Related Literature and Study

Public and private hospitals in Bangladesh: service quality and predictors of hospital choice.

This study compares the quality of services provided by public and private hospitals in Bangladesh. The premise of the paper was that the quality of hospital services would be contingent on the incentive structure under which these institutions operate. Since private hospitals are not subsidized and depend on income from clients (i.e. market incentives), they would be more motivated than public hospitals to provide quality services to patients to meet their needs more effectively and efficiently. This premise was supported. Patient perceptions of service quality and key demographic characteristics were also used to predict choice of public or private hospitals. The model, based on discriminant analysis, demonstrated satisfactory predictive power.

Private hospitals were evaluated better on responsiveness, communication, and discipline. By responding to these needs, hospitals in Bangladesh can improve their image and be perceived more favorably. These results also suggest that service quality can be improved in the health care sector by gradually exposing the hospitals to market incentives. It is important, especially for public hospitals and regulatory agencies, to

understand how market incentives work. With better understanding and over time, public hospitals may be gradually weaned from their present survival guarantees that do not seem to motivate them to enhance service quality; such guarantees are also not available to private hospitals. The results suggest that quality perceptions are driving many patients to private hospitals (e.g. the sample of this study shows that a greater proportion of patients are seeking private care). (Syed Saad Andaleeb, Oxford University Press, 2000).

Private Delivery and Public Goals: Mechanisms for Ensuring that Hospitals Meet Public Objectives

How can government ensure that private delivery still adheres to societal goals? In particular, what mechanisms are available to ensure that private hospitals nonetheless act in accordance with broader public objectives? Although these issues affect most countries, this paper will focus upon industrialized countries where there is enough wealth to be able to provide universal, high quality health care to all who need it, without needing to sacrifice other social goods. In all such countries, the level of health expenditures is high enough that it is feasible to provide a high level of services (defined in terms of quality and timeliness), although this does not necessarily extend to provision of any and all services which might be demanded. The paper will focus only upon those jurisdictions where at least some hospitals are independently owned and operated, and the

mechanisms used must accordingly be indirect. It will deal primarily with hospitals, rather than other sub-sectors (e.g., long-term care/nursing homes) where private delivery is common, but care is less complex. The analysis accordingly draws from both general analyses of health care systems, and from brief case studies of four jurisdictions Australia,Ontario (Canada), Germany, and the Netherlands. The paper begins by distinguishing among three elements of health care systems (financing, delivery, and allocation) and multiple levels of public and private. The analytical framework employed includes the following elements; Categorization of hospitals by ownership type; Specification of goals the system might wish to attain; Specification of policy instruments which might be used to realize these goals; andSpecification of which actors would ensure that the goals are being met. The COTG (Centraal Orgaan Tarieven Gezondheidszorg), an arms length organization with membership from national organizations of hospitals, sickness funds, and private insurance companies, was given the legal authority to review and approve negotiated prices; it also developed policy guidelines, gave advice to the Minister of Health, and provided an arbitration mechanism if the parties could not agree. However, the Ministry had the authority to limit the room for negotiations by giving binding instructions about policy guidelines. This transformed the expenditure instrument by giving it more regulatory teeth; its decisions were legally binding, and enforced by the then-Ministry of Welfare, Health and Culture.The main innovation was to replace the COZ guidelines which had been used to calculate the per diem charges used to pay hospitals by capped annual global expenditure limits, established through negotiation between sickness funds,

private insurers and hospitals. This exercise was intended to enforce cost control by controlling volume; it also shifted the balance of power between medical staff and hospitals. The basis for constructing these budgets has also varied over time. As noted, budgets had initially been based on a per diem payment, which encouraged volume. In 1983, the Netherlands introduced budgeting based on a fixed, historical basis; this was then replaced by functional budgeting in 1988, which sought to ensure that hospitals providing the same functions received equal budgets. The formula included elements based on the population in the hospitals catchment area (availability), the number of authorized beds and specialist units (capacity), and the projected service volumes (production); the latter was determined in annual negotiations between the hospital management and the payers (both sickness funds and private health insurers). (Raisa Deber, PhD,2004)

Inpatient satisfaction: an analysis of Malaysian public hospitals

The purpose of this paper is to provide an empirical analysis on inpatient satisfaction in Malaysian public hospitals. A self-administered questionnaire was the main data collection method. Altogether, 23 hospitals throughout Peninsular Malaysia participated in the survey. Cluster sampling was used in the selection of the respondent hospitals, while convenience sampling was used in administering the survey. The research was limited to inpatients of Malaysian public hospitals. A thorough evaluation of the nation's public healthcare delivery system would need to include outpatient services as well.

Three factors of inpatient satisfaction were extracted, which were clinical and physical dimensions of service, and additional facilities for patients and family members. Inpatient satisfaction was found to be higher for the clinical dimension than for the physical dimension. Overall, inpatient satisfaction was high, as reflected by the high mean score of the variables, although caution was expressed in interpreting the findings, particularly the low expectations of patients to begin with (Noor Hazilah & Abd Manaf, 2012)

Public Health in Hospitals: The Missing Link in Health Improvement

Traditionally, public health professionals have scorned hospitals as the antithesis of community health. Secondary care remains notably distant from public health practice and policy. Yet hospitals consume over 50 percent of the health budget and over a quarter of the population have contact with hospital services every year. There is an important public health agenda in promoting health and an environment that encourages community partnership and a healthy place to work and be. Public health skills have a key role in ensuring high-quality, safe and evidence-based health care. Epidemiological support for hospitals can promote a much needed culture of monitoring and evaluation of health services public health approach to planning of secondary care services can encourage a more objective and strategic assessment of health needs and how these are best met. (John Wright, Anthony Franks, Philip Ayres ,2002)

Having a Baby: Pregnancy and Birth in Hong Kong

There are a number of government and private hospitals with maternity wings. Costs vary between facilities. Many hospitals have their own websites where they publicise their facilities and charges.

Government hospitals are heavily subsidised but have experienced problems recently with women coming from mainland China to give birth in their facilities and then return home again as Hong Kong law states that a child born in Hong Kong to a parent from China has a right to Hong Kong residency. This has led to public hospitals being full and unable to take women wishing to give birth in them. The Government is trying to address this issue to avoid further problems.

Pregnant women are advised to book their hospital as soon as possible in the pregnancy, particularly if they wish to make use of public facilities. Some women choose to book both a public and private hospital in case one is not available. The Community Advice Bureau can provides information on the English-speaking maternity facilities.

Private hospitals are popular with many expatriates but they have been criticized for being too quick to deliver babies by Caesarean section. According to recent research one in two births in a private Hong Kong hospital is by C-section.

A woman not eligible for subsidized or free care in a government hospital will "go private". In the private sector, doctors' fees may be charged separately and on top of the hospital fees as they work independently of them. In the event of any emergency

procedure the costs in a private hospital will increase dramatically. Be aware that not all health insurance policies will cover maternity or childbirth.

The length of time spent in hospital will depend on the hospital and on the circumstances surrounding the birth; public hospitals typically limit stays to three days while stays of five days are common in private hospitals. (AngloINFO, Everyday Life in HongKong, 2000-2012)
Finding the right hospital in the Philippines is not that difficult because there are a number of options to choose from. The Philippines has both private and public health care institutions. Most of the government hospitals provide quality healthcare the same way private hospitals do.

Health Care in The Philippines

Some people have these wrong misconceptions though than when you are seeking for medical advice from doctors in public hospitals, these are not reliable. However, you should be aware that most of the well-trained doctors in the Philippines are serving government hospitals. What differs the Philippine government hospitals from the Philippine private hospitals is simply the facilities. Most of the public hospitals in the Philippines are not equipped with the latest technologies in medicine. But then, most Filipinos seek for advice from these government hospitals because charges are not implemented.

As for the private hospitals, there are also a hundred ones located in key cities of the nation. There are also tertiary hospitals that have the latest in medical technologies. However, because they are private hospitals, they are a bit expensive than the government hospitals (Jose Marc Castro,2009).

Theoretical Framework

The Neuman Systems Model is based on the patient's relationship to stress, reaction to it, and reconstitution factors that are dynamic. The Neuman Systems Model is universal in nature, which allows it to be adapted to a variety of situations, and to be interpreted in many different ways.

The central philosophy of Neuman's nursing theory consists of energy resources that are surrounded by three things: several lines of resistence, which represent the internal factors helping the patient fight against a stressor; the normal line of defense, which represents the patient's equilibrium; and the flexible line of defense, which represents the dynamic nature that can rapidly change over a short time.

In the Neuman Systems Model, the nurse's role is to keep the system's stability by using three levels of prevention. The first is primary prevention, which protects the normal line and strengthens the flexible line of defense. The secondary prevention is used to strengthen the internal lines of resistence, which reduces the reaction and

increases resistence factors. Finally, tertiary prevention readapts, stabilizes, and protects the patient's return to wellness after treatment.

CHAPTER 3 Research Methodology Research Design The study utilized a descriptive tool to identify the cost of healthcare between two delivery cases in public and private hospitals. The study was used to describe and compare the cost of the two delivery cases. In descriptive studies, phenomena are described or the relationship between variables is examined. A descriptive study is similar to an exploratory study. However, the two categories can be distinguished by considering the amount of information that is available about the variable(s) under investigation (Nieswiadomy, 2008). Locale and Population of the Study The study will be conducted in the house of respondents located in Valenzuela from June to July 2012 . Four respondents will be participating in the compliance of the study. The study was conducted particularly at the OB ward of the selected hospital. Description of the Respondents The study will ask four pregnant women who is about to give birth here at the chosen hospitals in Valenzuela City. The respondents served as the key in identifying the cost between the two delivery cases in public and private hospitals. To identify the cost differences the researcher made use of documentation analysis of the expenses that the respondents has daily.

Instrumentation The researchers will use documentation analysis in gathering the essential datas. Guided by the goals of the study the researchers