Philippines

Original Editor - Mary Ramos.

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Patient Access to Physiotherapy or Physical Therapy Services / Entry Point

    Residents of the Philippines can access Physical Therapy services through referral by their primary care physician if they are not hospital in patients. The out patient clinics are mostly affiliated to a major hospital that employs physiatrists (doctors of rehabilitation medicine). They evaluate the patient and prescribe both medical and physical therapy prescriptions. Further medical testing such as imaging, lab tests and medication prescriptions are accomplished during the initial visits. Physical therapy prescriptions include the modalities, tx frequency, and duration. The patients then bring the prescription to the physical therapist who performs the evaluation and the prescribed treatment.
The second method of access is for the hospital in patients. Following surgery or any other medical illness, the patient will be referred to the Rehab department. The physiatrist will be the first responder performing evaluation and writing rehab prescription. The acute care physical therapist will then conduct the PT evaluation and the prescribed treatment regimen.
The last method of PT access is through private care. Through private pay negotiation, the patient gets to be seen at home without the need for primary care or physiatrist prescription. There are small out patient clinics run and operated by the physical therapists.

In Philippines direct acces to physiotherapy is not permitted, but it is allowed for physiotherapists to act as first contact/autonomous practitioners.

Therapist Preparation

      Degree/Credentialing

The Commission on Higher Education (CHED) issues memoranda and guiding instruments for all formal college education, including physical therapy. Its Technical Panel on PT Education monitors compliance of colleges and universities with physical therapy programs to educational standards.
As of January 2011, there are ninety-four (94) local higher education institutions with a Bachelor of Science in Physical Therapy program.
As of June 2011, three (3) higher education institutions are known to offer master’s degrees in physical therapy.

In the Philippines, the physical therapy program is 5 years in length awarding the Bachelor of Science in Physical Therapy. Students undergo 10 months of rotating internship in relevant institutions such as hospitals and clinics to complete the required clinical internship program of 2,000 hours. A graduate of BS in Physical Therapy needs to pass the Physical Therapist Licensure Examination in order to practice as a registered physical therapist in the Philippines. The examination is given by the Board of Physical and Occupational Therapy under the supervision of the Professional Regulation Commission (PRC).

      Specialization

Special interest groups recognised by Philippine Physical Therapy Association:
Educators in physical therapy.

Licensed clinicians get to specialize in certain areas of care depending on where they get to be employed. For example, physical therapists who work at the Lung Center of the Philippines get to be more adept with pulmonary rehabilitation. While others who get to work at the Heart Center of the Philippines become experts in cardiac rehabilitation. Philippine General Hospital for example becomes the training center for everything. As of this date there are no credentialing institutions or specialty schools/training centers that grants certification for some type of specialization. PT graduates however can pursue Master of Science in Physical therapy from two accredited universities.

Professional Associations

 The Philippine Physical Therapy Association, Inc. (PPTA) is a local professional organization of Filipino physical therapists recognized by the  Philippine Professional Regulation Commission. PPTA, in its Mission-Vision-Goals 2010, envisions Physical Therapy to become a legally mandated autonomous profession with established areas of specialization, the value of excellence in service upheld in its practice, and at the same time being recognized by clients, colleagues and the community. The Association strives to be the visible and accessible organization of Filipino physical therapists, advancing the welfare of the members of the Association, and physical therapists in general. It will be comprised of active members in pursuit of competent and ethical practice towards the provision of effective and efficient services for the Filipino people. PPTA is a member organization of the  World Confederation for Physical Therapy and the  Asian Confederation of Physical Therapy.

Information about the Patient Communit

The country’s projected population for 2010 was 94 013 200. It is predominantly young, with the 0-14 years age group representing 33.8% and those aged 65 years and above comprising only 4.4%. There are almost equal numbers of males and females. The crude birth rate is 19.7 per 1000 midyear population and the crude death rate is 5.0 per 1000 midyear population. Life expectancy for both sexes was 70 years in 2009: 67 for males and 73 for females.
Noncommunicable diseases (NCD) are considered a major public health concern in the Philippines, accounting for six of the top 10 causes of death. Diseases of the heart and vascular system are the leading causes of mortality, comprising nearly one-third (31%) of all deaths. Other NCD topping the list include malignant neoplasms, chronic obstructive pulmonary disease (COPD), diabetes mellitus, and kidney disease.
Accidents of all types, including road traffic crashes, rank 10th among the causes of mortality for all age groups. Road traffic accidents constitute the fifth leading cause of injury death, with a mortality rate of 39.1/100 000.
Among children aged 0-17 years, it is the second leading cause of injury death (mortality rate of 5.85/100 000),  next to drowning.
Seven of the 10 leading causes of morbidity in 2009 are caused by infections. They are: acute respiratory infection; pneumonia; bronchitis/bronchiolitis; acute watery diarrhoea; influenza; urinary tract infection and tuberculosis. Among these communicable diseases, pneumonia and tuberculosis continue to be among the 10 leading causes of mortality, causing a significant number of deaths across the country.
At the same time as deaths due to preventable diseases have been in a decline, lifestyle-related diseases have begun to dominate in the leading causes of death, particularly heart diseases, diseases of the vascular system, malignant neoplasms, diabetes mellitus, and chronic lower respiratory diseases. However, certain conditions originating in the perinatal period are also among the 10 leading causes of mortality, illustrating the vulnerability of the newborn child.

Social/Cultural Influences

    The strong feeling for family, a quality derived from Chinese influence, is manifested by old fashioned patterns imposed by the family patriarch or equally authoritative matriarch. Respect and deference are always given to one’s elders, whose words and decisions gets the most weight. The younger family members are unconditionally under protection and responsibility of their elders. The implications for health care are important. Filipino patients always have their families hovering over them, perhaps to the irritation of the medical staff. The sick Filipino child feels lost without his mother constantly at his bedside. When grandparents are ill, sons, daughters and even grandchildren take turns keeping them company and doing everything for them. This would require patient and family education on rehabilitation goals set by the therapists promoting functional independence. A daughter who just had a baby may follow a traditional customs related to activity, food and hygiene which may be contrary to what the doctor or nurse prescribes.

Delivery of Care

• Is delivery of care provided in a timely manner?
• Special methods? Home health etc
  

    The timeliness of the care delivery varies on the location. Huge metropolitan cities like Manila and Cebu are able to deliver more Home health services due to its close proximity to many universities offering physical therapy. However, the situation is much thinner compared to rural areas where the patients end up travelling more distance and longer waiting period to the closest provincial hospital providing Physical therapy services. For in patient care in the tertiary level of health care facilities, these hospitals are sufficiently staffed to provide rehab services as soon as the order is written. They are usually equipped with out patient services which provide continuity of warranted skilled intervention. Unfortunately, on the primary and secondary levels of health care facilities very rarely will you find therapy services being available. The closest option will be a referral for home health therapy providers.
LEVELS OF HEALTH CARE FACILITIES
1. PRIMARY LEVEL OF HEALTH CARE FACILITIES
- are the rural health units, their sub-centers, chest clinics, malaria eradication units, and schistosomiasis control units operated by the DOH; puericulture centers operated by League of Puericulture Centers; tuberculosis clinics and hospitals of the Philippine Tuberculosis Society; private clinics, clinics operated by the Philippine Medical Association; clinics operated by large industrial firms for their employees; community hospitals and health centers operated by the Philippine Medicare Care Commission and other health facilities operated by voluntary religious and civic groups (Williams-Tungpalan, 1981).
2. SECONDARY LEVEL OF HEALTH CARE FACILITIES
- are the smaller, non-departmentalized hospitals including emergency and regional hospitals.
- Services offered to patients with symptomatic stages of disease, which require moderately specialized knowledge and technical resources for adequate treatment.

3. TERTIARY LEVEL OF HEALTH CARE FACILITIES
- are the highly technological and sophisticated services offered by medical centers and large hospitals. These are the specialized national hospitals.
- Services rendered at this level are for clients afflicted with diseases which seriously threaten their health and which require highly technical and specialized knowledge, facilities and personnel to treat effectively (Williams-Tungpalan, 1981) (6).

Type of Health System

•     Health Care Delivery System

The state recognizes health as a basic human right. It protects and promotes the right to health of the people and instills health consciousness among them. Although this provision is guaranteed by the 1987 Constitution (Article II, Section 15) and the health care system in the Philippines is generally extensive, access to health services, especially by the poor, is still hampered by high cost, physical and socio-cultural barriers. To address these concerns, reforms in the country’s health care system have been instituted in the past 30 years: the adoption of Primary Health Care in 1979; the integration of public health and hospital services in 1983 (EO 851); the enactment of the Generics Act of 1988 (RA 6675); the devolution of health services to LGUs as mandated by the Local Government Code of 1991 (RA 7160); and the enactment of the National Health Insurance Act of 1995 (RA 7875). In 1999, the DOH launched the Health Sector Reform Agenda (HSRA) as a major policy framework and strategy to improve the way health care is delivered, regulated and financed.
The Philippines has a dual health system consisting of: the public sector, which is largely financed through a tax-based budgeting system at national and local levels and where health care is generally given free at the point of service (although socialized user charges have been introduced in recent years for certain types of services), and the private sector (consisting of for-profit and non-profit providers), which is largely market-oriented and where health care is paid through user fees at the point of service. The expansion of social health insurance in recent years and its emergence as a potential major source of health financing will have a positive impact on the health care system in terms of health provider practices by both the public and private sectors and in terms of the people’s health-seeking behavior.
Under this health system, the public sector consists of the DOH, LGUs and other national government agencies providing health services. The DOH is the lead agency in health. Its major mandate is to provide national policy direction and develop national plans technical standards and guidelines on health. It has a regional field office in every region and maintains specialty hospitals, regional hospitals and medical centers. It also maintains provincial health teams made up of DOH representatives to the local health boards and personnel involved in communicable disease control (6).
All public health institutions except regional hospitals/public medical centers provide free health care services which comprise primary and secondary care. People are supposed to be able to access basic health care free of charge. The national health insurance program is managed by Philippine Health Insurance Corporation (Philhealth). There are five programs depending on the employment status and the funds are cross subsidized between the pools (7).

Payment System

    The following two schemes are the principal system in the Philippines: budgeting for public health institutions, and fee-for-service for private health institutions/providers. There is no fee schedule for health care services in the Philippines. Non insured patients have to bear all health costs based on the fee-for-service and non fee schedule schemes when they have private health services. The insurance system is co-payment; that is, insurance covers defined costs for certain health services, and patients bear the remaining costs. Hence, the payment system for insured people is composed of fee-for-service, non fee schedule, and copayment schemes in the Philippines. The public health service is basically provided free of charge. Therefore, patients are not supposed to bear any financial risks when they access free public health care services. However, patients might be requested to make informal payments including donations (7).

References

6. Health Care Delivery system in the Philippines @ www2.doh.gov.ph/noh2007/NOHWeb32/…/HealthCareDel.pdf. accessed November 11, 2010.
7. Philippine Health Payment System @ http://www.ide.go.jp/English/Publish/Dowload/Jrp/pdf/142 3.pdf. Accessed November 11, 2010.