1

EXECUTIVE SUMMARY

Title: Knowledge, Attitude and Extent of Utilization of PhilHealth

Primary Care Benefit 1 (PCB 1) Package among Indigents and
LGU Sponsored Members in Iloilo City

Total No. of Pages: 126

Researcher: Arlie Maleriado Marmolejo

Degree Program: Master of Arts in Nursing

Institution: Central Philippine University

Jaro, Iloilo City
Region VI

Background and Rationale of the Study

The 1987 Constitution provides that all Filipinos should have access to health

services. This policy finds full expression in Article II, Section 15: “The State shall

protect and promote the right to health of the people and instill health consciousness

among them.” Article XIII, Section 11 provides that “The State should adopt an

integrated and comprehensive approach to health development which shall endeavor to

make essential goods, health and other social services available to all the people at

affordable costs. There shall be priority for the needs of the underprivileged, sick, elderly,

disabled, women and children. The State shall endeavor to provide free medical care to

paupers.” Philippine Constitution (1987).

Many developing countries promote social health insurance as a powerful

instrument to eliminate unmet health needs. However, even as countries find the

resources needed for universal coverage, this alone may not be enough to ensure access
 2

and appropriate care. One of the least understood problem is the lack of utilization of

social health insurance among the insured. Studies have shown that patient perceptions of

quality of care, cultural, economic, and geographical factors can affect the utilization of

health services in social health insurance programs in developing countries. Quimbo

(2008).

In developing countries it is particularly important to understand insurance

underutilization because the greatest burden of health care spending falls on the less

privileged and marginalized groups. In the Philippines, 46 percent of total health care

expenditures are accounted for by out-of-pocket payments with a support value of only

54 percent. PhilHealth Stats and Charts (2013). Insurance underutilization therefore

suggests that there is an ineffective use and distribution of public resources, missing the

intended poor households who lose out on financial resources to which they are entitled.

To address the remaining gaps and challenges on inequity in health, the Aquino Health

Agenda (AHA), through Administrative Order No. 2010-0036 was launched last 2010. It

contains the operational strategy called Kalusugan Pangkalahatan (KP) which aims to

achieve Universal Health Care for all Filipinos. KP seeks to ensure equitable access to

quality health care by all Filipinos beginning with those in the lowest income quintiles.

KP further fulfills President Aquino’s “social contract” with the Filipino people, as stated

in Section 7 of Executive Order 43 series 2011: The implementation of KP/Universal

Health Care shall be directed towards the achievement of the health system goals of

financial risk protection, better health outcomes and responsive health system.

In support of the Aquino Health Agenda to provide Universal Health Care for All

Filipinos, the Philippine Health Insurance Corporation introduced a program called

 3

Primary Care Benefit 1 (PCB1) Package and was launched on April 01, 2012 which aims

to expand the number of services included in the Primary Health Care Benefits for

PhilHealth Members; increase the utilization rate for services included in the Primary

Health Care Benefits; enhance the incentives for PCB providers to promote healthy

behavior, prevent diseases and/or associated complications, and facilitate appropriate

referral and lastly to ensure complete and timely reporting of health data for monitoring

and performance assessment and evaluation purposes. The target clients of this program

initially include the indigents, the sponsored program members, organized groups and

overseas workers programs members, and all their qualified dependents.

The PCB1 Package includes three (3) main provisions. The first provision include

the delivery of primary preventive services such as free consultation, visual inspection

with acetic acid, regular blood pressure measurement, breastfeeding program education,

periodic clinical breast examination for females, counseling for lifestyle modification and

smoking cessation, body measurements (Body Mass Index), and digital rectal

examination for males.

The second provision is about certain diagnostic examinations that should be

provided to the clientele as per case to case basis. Diagnostic examinations such as

Complete Blood Count (CBC), urinalysis, fecalysis, sputum microscopy, fasting blood

sugar, lipid profile and chest x-ray. The PCB1 provider shall ensure that these diagnostic

examinations are available to the clientele when needed. They may forge a Memorandum

of Agreement to higher facility to provide those diagnostic examinations that are not

available on their facility.

 4

The third provision is about the drugs and medicines that should be given to their

clientele whenever needed. These drugs and medicines includes medicines for Asthma

including the nebulization services, medicines for acute gastroenteritis with no or mild

dehydration, for Upper Respiratory Tract Infection and Pneumonia (minimal or low risk),

and drugs for urinary tract infection. PCB 1 providers shall ensure that their clients with

health care needs beyond their service capability must be referred to appropriate health

care facilities.

Statement of the Problem

PhilHealth together with the Department of Health and the Local Government

Unit conducted several information dissemination campaign to empower the target

consumers of this program. Series of symposia and fora were conducted in every

Municipality and District Health Center about the benefits and privileges offered under

the PCB1 Package and the process of availing it. One best example of this is the Alamin

at Gamitin (ALAGA KA) Program, a joint campaign of the DOH and PhilHealth to

inform the population of the services and benefits they could avail from PhilHealth and

other Health services offered by the Department of Health.

Despite all the information dissemination from activities, still many indigents and

LGU sponsored members are still unaware of the existence of the PCB 1 Package. Many

still do not know the procedure on how to avail of the benefits. But even if they are aware

and knowledgeable, some still do not readily comply with the required documents

because of limitations such as mobility or preoccupation of responsibilities at home. Italia

(2012).
 5

The indigents and Local Government Unit (LGU) sponsored members should be

well informed about their privileges and benefits provided for them under the PCB

1Package. Moreover, they should be enjoying the full use of these benefits and privileges

that they are entitled.

It has been two years since the implementation of PhilHealth Primary Care

Benefit 1 (PCB1) Package, and the assessment of its utilization among the target clientele

and to the health care industry is necessary. After searching for available literature on the

subject, the researcher has not found any, thus the researcher decided to conduct this

study to find out the knowledge, and understanding on the utilization of PhilHealth’s

PCB1 program and services. The findings of this study will help in the continuing effort

of PhilHealth together with the Local Government Unit and the Department of Health to

monitor the efficiency and effectiveness of the delivery of its health care program to the

Filipino people.

General Objective

The main objective of this study is to determine the knowledge, attitude extent of

utilization of PhilHealth Primary Care Benefit 1 (PCB 1) Package among indigents and

LGU sponsored members in Iloilo City.

Specific Objectives

Specifically, this study aimed:

1. to determine the socio-demographic profile of the respondents in terms of age,

sex, civil status, educational attainment, average monthly family income, and

distance of residence from the health center;

 6

2. to determine the respondents’ level of knowledge about the PhilHealth PCB1

Package;

3. to determine the respondents’ attitude towards the PhilHealth PCB 1 Package;

4. to determine the respondents’ extent of utilization of PhilHealth PCB 1 Package;

5. to determine if there is a significant relationship between the socio-demographic

profile of the respondents and their knowledge of the PhilHealth PCB 1 Package;

6. to determine if there is a significant relationship between the socio-demographic

profile of the respondents and their attitude towards the PhilHealth PCB

1Package;

7. to determine if there is a significant relationship between the socio-demographic

profile of the respondents and the extent of Utilization of the PhilHealth PCB 1

Package;

8. to determine if there is a significant relationship between the respondents

knowledge and their attitude towards the PhilHealth PCB 1 Package;

9. to determine if there is a significant relationship between the attitude of the

respondents towards and the extent of utilization of PhilHealth PCB 1 Package;

10. to determine if there is a significant relationship between the respondents

knowledge about and the utilization of the PhilHealth PCB 1 Package;

11. to determine whether there is a significant relationship between the knowledge

about and utilization of PhilHealth PCB 1 Package when attitude is controlled.

 7

General Assumption

This study is anchored on the theory of Reasoned Action by Martin Fishbein and

Icek Ajzen (1975) which posits that a person’s behavior is determined by its behavioral

intention to perform it. This intention is itself determined by the person’s attitudes and his

subjective norms towards the behavior.

The theory of reasoned action proposes that a person’s attitude towards the

behavior and the subjective norms will determine the person’s behavioral intention to do

a certain behavior. The attitude toward the behavior refers to the sum of beliefs about a

particular behavior when weighed by the evaluation of these beliefs and the subjective

norms. This refers to the influence of people in one’s social environment on his/her

behavior. When an individual believes that the advantage of doing the behavior is greater

than its disadvantage then he/she decides to act on the behavior especially when he/she

expects to benefit from it.

Applying the theory to this study, it is assumed that the respondents’ utilization of

the benefits and privileges of the PhilHealth PCB 1 Package may be influenced by their

attitude towards the package, which in turn may be influenced by the amount of

knowledge on which it is based and how it was acquired. Knowledge and attitude are

expected to vary according to the characteristics of the respondents.

In the context of age, it is assumed that the older individuals who are

knowledgeable about the benefits and privileges of the PCB1 Package may have a

favorable attitude and are more likely to avail of its services. However, some age-related

diseases or cognitive deficits may make them physically handicapped, and this conditions

may prevent them from utilizing the services. Furthermore, middle-age group individuals
 8

may have more knowledge on the benefits and privileges of the PCB1 Package, however

they may be too busy or preoccupied with responsibilities at home or at work that they

cannot have the time to avail of the services.

Both men and women have equal opportunities of learning about and utilizing the

PCB 1 Package, however men may not utilize these benefits as much as women would

because of the need to maintain their masculine image making them more reluctant to be

identified as weak and easily to get sick.

It is assumed that being married has the assurance of family support. However,

the widowed and separated individual may also have the support of their children and

friends. Married individuals may share and motivate their partners to avail of the benefits

and privileges of the PCB1 Package, while the widowed or separated individuals living

alone may not avail of the services in PCB1 Package since nobody motivates them to

avail the benefits and privileges of the package.

With regards to the educational attainment, the higher the educational level the

respondents have completed, the more likely that they have better knowledge and attitude

towards the utilization of the benefits and privileges. On the other hand, those with low

education may also obtain some information about the benefits and privileges of the PCB

1 Package through media, radio, television or even the word of tongue from their

associates thus making them utilize their benefits and privileged.

It is also assumed that the income earned by the individuals may affect their

decision to avail of the PCB1 Package. It may be expected that those with low income are

more likely to utilize the benefits and privileges much more often than those with higher

income as the need of the former for socio-economic assistance may be greater. On the
 9

other hand, the opposite may be true to those with low income who may not have enough

money to sustain their daily living such as food and other basic necessities, and thus may

not give priority to purchasing medicines after being diagnosed with a disease.

Distance from the health care facilities may play a role in the utilization of

benefits and privileges of the PCB1 Package. It is assumed that those who live far from

the health care facility may find it bothersome and may not utilize the benefits and

privileges stipulated under the PCB1 program, while those who live near the health

facilities may utilize its services more often. On the other hand, those who reside far from

the health care facility may still be eager to avail of the benefits and privileges they are

entitled since the necessity of it is far more important than the distance.

It is also presumed that knowledge about the benefits and privileges under the

PCB 1 Package which is considered in this study as independent variable is believed to

have an important influence in the utilization of health services. Indigents and LGU

sponsored members who are well informed about the PCB1 Package would likely be

more wager to avail the said Package. Furthermore, it is believed that attitude of the

respondents towards the benefits and privileges of PCB 1 Package may also influence the

utilization of the Package. Those respondents who had a favorable attitude towards that

package may more likely to utilized it to those who had an unfavorable attitude towards

the benefits and privileges of the PCB1 Package.

 10

Research Design

This study is a descriptive relational type of research which used a one - shot

survey design. In this study, the personal profile of the respondents, the indigents and

LGU sponsored members in terms of age, sex, civil status, educational attainment,

average family monthly income, and distance from the Health Center are described. Their

knowledge about the benefits and privileges in the Primary Care Benefit 1 (PCB1)

Package, their attitude towards the package and their utilization of it were measured and

analyzed. Furthermore, the relationship between the respondent’s personal profile, their

knowledge, attitude and utilization were determined.

Study Population

The target population of this study consisted of the enlisted and profiled indigents

and LGU sponsored members in Iloilo City. Excluded from the survey were the senile

and cognitively impaired individuals. There are nine (9) District Health Centers in Iloilo

City from where the respondents were drawn. Stratified Random Sampling was employed

to determine the sample of this study. The list of profiled and enlisted members was

obtained from each District Health Center, and also from the Philhealth Master List. Both

data were compared to check for accuracy. The total population of indigents and LGU

sponsored program member in Iloilo City was 48,337 persons which comprised of the

enlisted and profiled members from different District Health Centers in Iloilo City.
 11

Using the following sampling formula, the total sample size for this study is 397

n = __N_
1+N (e) 2

Where: n = Sample Size,

N = Population Size and

(e) = margin of error at 0.05

The total sample size was then allocated to the different District Health Centers.

The sample per district health center was drawn using systematic sampling with a random

start. Every 10th name was picked from the list until the desired number of respondents

was reached.

Table 1. Proportionate Allocation of Respondents according to the District Health Centers

District Health Centers Population Sample Size

Arevalo 7601 62
Bo. Obrero 5259 43
Jaro I 2197 18
Jaro II 7495 62
Lapaz 2224 18
Mandurriao 7737 64
Molo 6314 52
Sto. Rosario 7037 58
Tanza 2473 20
TOTAL 48, 337 397
 12

Instrumentation

Data were collected using a structured interview schedule, constructed based on

the specific objectives composed of four parts. The first part gathered data on the socio-

demographic profile of the respondents such age, sex, civil status, educational attainment,

average monthly family income and distance of their residence from the Health Center.

The second part contains questions on knowledge of the respondents about the benefits

and privileges and how they could avail of the services under the PCB 1 Package. It was

composed of ten questions answerable by true or false. The third part determined the

attitude of the respondents towards the PCB 1 Package. It was composed of a ten items

answerable by a 4 point scale of “strongly disagree”, “disagree”, “agree”, and “strongly

agree”. The fourth part determined the respondents’ extent of utilization of the benefits

and privileges under the PCB 1 Package. It was composed of 13 questions. The

respondents were given the choice of “yes” and “no” with screening questions for the

utilization.

Validity and Reliability

The questionnaire underwent content validation and was submitted to a panel of

experts in the field of research, for accuracy, simplicity and clarity. Revisions were made

according to their suggestions, recommendations and comments before the conduct of the

actual survey. The questionnaire was translated to Ilonggo for the appropriate usage,

clarity, meaning and ease of use. Inconsistencies in the translation and different

understandings of concepts were discussed until a consensus was reached.

 13

The knowledge questionnaire, the attitude questionnaire and the utilization

questionnaire were tested for reliability by pre-testing them among the indigent and LGU

sponsored members (five percent of the sample size) from different backgrounds who

were not part of the study. A test-retest method was utilized to determine the reliability of

the questionnaires. A corresponding tabulated result of Correlation Coefficient revealed a

value of 0.901 for the knowledge questionnaire, 0.724 for the attitude questionnaire and

0.821 for utilization questionnaire. These results were then presented to a statistician

whose recommendations were incorporated in the final copy of the questionnaire. The

values indicated that the questionnaire were reliable and could be used in the study.

Data Gathering Procedure

The researcher trained three assistant researchers together with the staff

recommended by the each District Health Center since they know the respondents and the

location of their homes. They were given an orientation on how to conduct an interview

and simulated an interview process. They were also given the right to appoint an

authorized representative if they wish. They were informed that their participation was

voluntary and they could stop the interview at any time they wish. They were also given

ample time to respond to the interview. All responses were reviewed after each set of

questionnaire was received. Inconsistencies were clarified with the respondents, after

which, the questionnaires were scored and the data were tabulated.
 14

Ethical Considerations

A letter was addressed to the PhilHealth Regional Vice President, the City Mayor

and the Medical Health Officer of every District Health Center, requesting for permission

to conduct the study in the locality. A letter of consent and confidentiality was attached to

each questionnaire. The purpose and objective of the study were explained to the

respondents and they were assured of the confidentiality of the data they provide which

will be strictly used for the purpose of this study only.

Data Analysis and Statistical Treatment

The Statistical Package for Social Sciences software program was used to analyze

the data. A statistician was consulted before the implementation of the survey and data

analysis.

Descriptive statistics included the use of frequency counts and percentages to

present data about the personal profile such as age, sex, civil status, educational

attainment, average monthly family income and distance from District Health Center of

the respondents, as well their distribution according to level of knowledge, attitude and

their extent of utilization of their benefits and privileges under the Primary Care Benefit 1

(PCB1) Package. The inferential statistics employed to determine the relationship

between age, educational attainment, average monthly family income, place of residence

from the District Health Center and the level of knowledge as well as to the attitudes

towards benefits and privileges of PCB 1 Package was Gamma, for sex and civil status in

relationship to the level of knowledge as well also to the attitudes towards Primary Care

Benefit 1 (PCB1) Package Cramer’s V was utilized.

 15

For the relationship between age, educational attainment, average monthly family

income, distance from the District Health Center in relation to their utilization Gamma

was used. Moreover, the relationship between sex and civil status in relation to their

utilization of their benefits and privileges Cramer’s V was used. Gamma was employed

to determine the relationship between level of knowledge and attitude, level of

knowledge and extent of utilization, attitude and extent of utilization and between level of

knowledge and extent of utilization when attitude is controlled.

Summary of the Findings

Major findings of this study include:

1. Majority of the respondents were 35-47 years old, male, married, and attained

high school level of education. They were earning an average monthly income of

PhP 5,000.00 to PhP 10,000.00 and they resides 1km to 3km away from any of

the District Health Centers in Iloilo City.

2. They had a high level of knowledge about the benefits and privileges of the

PhilHealth Primary Care Benefit 1 (PCB1) Package.

3. The respondents had a highly favorable attitude towards the benefits and

privileges of the PCB 1 Package.

4. They had a low extent of utilization of the benefits and privileges that they are

entitled under the PCB 1 Package.

5. There was a significant relationship between the respondents’ educational

attainment and level of knowledge about the benefits and privileges of the PCB 1

Package, However the findings of the study revealed that socio-demographic

 16

profile of the respondents’ such as age, sex, civil status, average monthly income,

and distance from the district health center were not significantly related to the

respondents level of knowledge on the PCB1 Package.

6. There was a significant relationship between the respondents’ age, sex, civil

status, educational attainment, average monthly family income, but not between

the distance of their place of residence from the district health center and their

extent of utilization of the benefits and privileges of the PCB 1 Package.

7. No significant relationship was found between the level of knowledge and the

respondents’ attitude towards the PCB 1 Package. Thus the null hypothesis that

there is no significant relationship between level of knowledge and attitude

towards the Primary Care Benefit 1 (PCB1) Package cannot be rejected.

8. A significant relationship was found between the respondents’’ attitude towards

the PCB 1 Package and their extent of utilization of the benefits and privileges.

Therefore, the null hypothesis that there is no significant relationship between

attitude towards and their extent of utilization of Primary Care Benefit 1 (PCB1)

Package is rejected.

9. No significant relationship was found between the respondents’ level of

knowledge and their extent of utilization of the benefits and privileges of PCB 1

Package. Therefore, the null hypothesis that there is no significant relationship

between level of knowledge and their extent of utilization of the PCB 1 Package

is accepted.

10. No significant relationship was found between the respondents’ level of

knowledge and their extent of utilization of the benefits and privileges of PCB 1
 17

Package for those who are highly favorable and those who have favorable

attitude. The null hypothesis that there is no significant relationship between level

of knowledge and their extent of utilization of PCB 1 Package when attitude is

controlled cannot be rejected.

Conclusions

In view of the findings, the following conclusions have been drawn:

1. Most of the respondents from 9 District Health Centers in Iloilo City were at

middle – aged, male married, high school eduated and were earning an average

monthly income of PhP 5,000 to PhP 10,000. Most of them reside near the

District Health Center.

2. The indigent and LGU - sponsored program members had a high level of

knowledge about the benefits and privileges of the PCB 1 Package which is an

indication that they were knowledgeable of the programs implemented by

PhilHealth.

3. Attitude towards the benefits and privileges of the PhilHealth Primary Care

Benefit 1 (PCB1) Package was highly favorable which indicates that the indigent

and LGU - sponsored members are convinced about the value and the efficacy of

the PhilHealth package program.

4. The extent of utilization of the benefits and privileges among the indigent and

LGU - sponsored members was poor despite the fact that they have high level of

knowledge and favorable attitude towards the PCB 1 Package.

 18

5. Only educational attainment has a significant influence on the indigent and LGU

sponsored members’ knowledge about the benefits and privileges. Age, sex, civil

status, average monthly income and distance of their place of residence from the

district health center are not significantly related to the level of knowledge about

the PCB 1 Package.

6. Only sex has a significant bearing on the attitude of the indigents and LGU

sponsored members towards the benefits and privileges of the PCB 1 Package.

7. Only distance of their place of residence from the district health center has no

significant bearing on the respondents’ extent of utilization of their benefits and

privileges of the PCB 1 Package.

8. The level of knowledge about the benefits and privileges of the PCB 1 Package

has no significant bearing on the attitude of the indigents and LGU - sponsored

members towards the benefits of the package.

9. The attitude of the indigents and LGU - sponsored members towards the benefits

and privileges of the PCB 1 Package has a significant impact on the extent

utilization of their benefits and privileges.

10. The level of knowledge of the indigents and LGU - sponsored members have no

direct effect on their extent of utilization of the benefits and privileges of the PCB

1 Package.

11. The level of knowledge of the indigent and LGU - sponsored members has no

significant bearing on the extent of utilization of their benefits and privileges both

for those who have a highly favorable attitude and those who have a favorable

attitude towards the PCB 1 Package.

 19

Recommendations

The following recommendations were based on the above mentioned conclusions:

1. Indigents and LGU - sponsored members should continue to seek for information

and be well informed about their benefits and privileges stipulated under the

Primary Care Benefit 1 (PCB1) Package so that they can fully maximize the use

of these benefits and privileges. Furthermore they will also motivate other

indigents and LGU - sponsored members to avail the benefits and privileges

provided for them under the PCB1 Package.

2. PhilHealth together with Local Government Units should identify areas of

weakness in the information dissemination and implementation of the benefits and

privileges for the indigents and LGU - sponsored members and initiate a program

of information dissemination and education to inform the target clients of their

benefits and privileges they are entitled to.

3. The PhilHealth together with the Local Government Units should coordinate hand

in hand to monitor and continuously check the implementation of the Primary

Care Benefit 1 (PCB1) Package. This is vital to make sure that the District Health

Center and their Health Care Providers are aware of their responsibilities in

providing the target clients their benefits and privileges as what they deserve.

4. PhilHealth and Department of Health should coordinate with the LGU’s and the

District Health Centers to offer seminars, conduct fora and trainings to empower

and to enhance the knowledge of the target clients regarding their benefits and

privileges under the Primary Care Benefit 1 (PCB1) Package.

 20

5. This study should be replicated among Primary Care Benefit 1 (PCB1) Providers

outside of Iloilo City to further validate the results of this study.