Antique, Guimaras two of 27 PHL provinces with less than 0.5 hospital beds per 1,000 population

The Philippine Health Insurance Corporation (PhilHealth) and relevant stakeholders must prioritize raising the number of accredited hospital beds in Luzon and Mindanao, the two island groups with the lowest hospital bed density, to meet the health demands of the population, according to a study of state think tank Philippine Institute for Development Studies (PIDS).

In “Spatiotemporal Analysis of Health Service Coverage in the Philippines”,  authors PIDS Senior Research Fellow Valerie Gilbert Ulep, Supervising Research Specialist Jhanna Uy, and research consultants Clarisa Joy Flaminiano, Vicente Alberto Puyat, and Victor Andrew Antonio assessed PhilHealth’s facility coverage by computing the proportion of accredited beds per province per 1,000 province population and analyzing data by hospital ownership (public and private) and hospital level as defined in the Universal Healthcare Act (Republic Act [RA] 11223).

It used PhilHealth data from 2018 to 2021 and auxiliary datasets from the Department of Health (DOH), Philippine Statistics Authority, and Washington-based Institute for Health Metrics and Evaluation to generate locality-based trends and insights.

Ulep and co-authors emphasized that hospital bed sufficiency remains “a widespread challenge” in the country.

Though Regions III, IV-A, and National Capital Region have the highest median hospital bed capacity (0.735) that comes close to DOH’s recommended ratio of one bed to 1,000 population, the lower median density of Visayas (0.728), Luzon (0.568), and Mindanao (0.555) reveals the urgent need to prioritize the availability of beds as the country recovers from the COVID-19 pandemic.

Provinces with less than 0.5 per 1,000 population bed density are Palawan (0.499), Pangasinan (0.485), Samar (0.474), La Union (0.469), Oriental Mindoro (0.464), Surigao del Sur (0.429), Romblon (0.428), Antique (0.417), Aurora (0.336), Marinduque (0.314), Sarangani (0.306), Northern Samar (0.29), Maguindanao (0.29), Agusan del Sur (0.285), Lanao del Sur (0.276), Zamboanga, Sibugay (0.262), Basilan (0.254), Ifugao (0.241), Davao Oriental (0.226), Tawi-Tawi (0.214), Zamboanga del Norte (0.198), Sulu (0.15), Davao de Oro (0.141), Guimaras (0.133), Occidental Mindoro (0.096), and Masbate (0.05).

Most of the provinces are located in Mindanao and with high poverty incidence and populations that are mostly indirect contributors of PhilHealth.

The study also identified healthcare service trends at the provincial level.

Hospital capacity disparity, which limits the readiness and availability of hospital services for subpopulations, is “most prominent in poorer provinces.”

Currently, efforts to raise the hospital bed capacity are in provinces with population coverage of 85 percent or higher, regardless of the poverty income cluster.

Median bed density also differs based on hospital ownership and level. The bed capacity of Level 2 and Level 3 public hospitals is lower than private hospitals.

Level 2 hospitals offer intensive care and specialist doctors on top of Level 1 hospitals’ minimum healthcare services, while Level 3 hospitals have training programs for doctors, rehabilitation, and dialysis units.

All provinces are required by RA 11223 to ensure access to Level 1 and Level 2 hospitals. According to the study, all provinces fulfilled this in 2021, but only 43 percent of Level 1 hospitals are government-owned.

About 94 percent of the 1,141 accredited hospitals are Level 1 and Level 2 hospitals. Level 3 hospitals (6%) are mostly located in richer provinces, which means those living in poor areas have no access to specialized services.

This “somewhat places a higher burden on Level 1 and 2 hospitals” in poor areas to provide effective primary care.

The study recommended “synergized efforts” led by PhilHealth and DOH to implement reforms and coordinate better healthcare service delivery.

It also suggested expanding the scope of services of healthcare providers in provinces with low primary healthcare facilities and increasing the access to primary care services in provinces with low bed capacity and high general admission rates.