Geographic, Clinician Shortage Issues

CHAPTER 2
REVIEW OF RELATED LITERATURE
The objective of this qualitative case study is to identify the factors that could affect the status
of medical services and the tactics needed to improve health services in tinambac Camarines Sur,
Philippines.
According to sombillo (2009) said that people's health is a reflection of the nation's wealth. As a
measure of the country's economic growth and development, the Human Development Index (HDI)
focuses on life expectancy. The use of health care is an example of the ability of the population to
improve the quality of life. Citizens' quality of life depends on the state of their health. Health
translation is largely dependent on the state's ability to provide basic health care services. Promoting
health among people in a country is based on the government's thrusts. In addition to improving citizens
' health, disease prevention often relies on the existing resources that are given to the health care
facility. Today, the country's health assessment is further transformed into the national health status of
rural communities. A detailed review and understanding is required for the use of health care services in
rural areas. This study is to be undertaken in this premise. The need to further examine the status of the
use of health care services is relevant in order to ensure priority is given to the health of the country.
GEOGRAPHIC, CLINICIAN SHORTAGE ISSUES

Patients living in rural areas are disproportionately more likely to struggle to access their clinician than a
patient living in an urban or suburban area.
According to the American Hospital Association
(2018), as many as 57 million Americans now live in a rural area. These people are facing a litany of chall
enges, from where they live to having enough doctors to provide care."Remote geographical location, s
mall size, limited workforce, physician shortages and often limited financial resources pose a unique set
of challenges for rural hospitals," AHA said in a recent rural health resource. Healthcare organizations
used telemedicine to close the gaps in care caused by geographical barriers. Direct-to-consumer
telemedicine enables patients to make video calls to a provider using their own computers or
smartphones. Across rural areas, several smaller hospitals will also use telemedicine to communicate
with specialists in more urban areas, stopping patients from traveling long distances to receive intensive
or advanced treatment. Patients living in rural areas also have to deal with a lack of physicians. Even in
urban areas, as the country sees an inevitable shortage of physicians, patients in rural areas feel the
pinch particularly worse. According to data from the National Rural Health Association 2018, the patient-
to-primary care physician ratio in rural areas is 39.8 doctors per 100,000 residents, compared to 53.3
doctors per 100,000 in urban areas. A separate report from the University of Nebraska Medical Center
found that the problems of clinician shortages affect rural areas throughout the world. While clinician
access to primary care is up 11 percent from 2008, doctors are still bracing to get hit hard by the
growing issue of national clinician shortage. Rural populations can experience many barriers to
healthcare access, which can contribute to health disparities.
TRANSPORTATION BARRIERS
From the article of PopHealth2018 summit archive stated that Even if a patient has access to a doctor
and can make an appointment, barriers to transportation will keep patients from seeing their clinicians.
Patients who are physically unable to drive, facing financial barriers or otherwise unable to obtain
transportation to the clinician's office often go careless. Approximately 3.5 million patients go without
treatment according to AHA estimates because they are unable to reach their providers ' transportation.
Transportation is a critical social determinant of health that has gained national attention. Additionally,
Distance and Transportation inRural populations are more likely to have to travel long distances to
access healthcare services, particularly subspecialist services. This can be a significant burden in terms of
travel time, cost, and time away from the workplace. In addition, the lack of reliable transportation is a
barrier to care. In urban areas, public transit is generally an option for patients to get to medical
appointments; however, these transportation services are often lacking in rural areas. Rural
communities often have more elderly residents who have chronic conditions requiring multiple visits to
outpatient healthcare facilities. This becomes challenging without available public or private
transportation.
In a study conducted by OECD, the World Bank and the world health organization (WHO)., (2018)said,

lowquality healthcare is increasing the global burden of illness and health costs.Today, inaccurate diagn
osis, errors in medication, inappropriate or unnecessary treatment, inadequate or unsafe clinical facilitie
s or practices, or providers lacking in training and expertise prevail in all countries. The worst condition is
low-and middle-income countries where 10% of hospitalized patients may expect to get an infection
during their stay, compared to 7% in high-income countries. This is despite the fact that hospital-
acquired infections are easily avoided by improved hygiene, improved infection control practices, and
antimicrobial use. At the same time, in high-income countries, one in ten patients was affected during
medical treatment. In the First World, the health problems of the ageing populations present the
greatest challenge. But there is also the growing complexity of the health system and servicing
organizations. Whereas scientists have developed highly effective treatments for many diseases, too
many people get inadequate, outdated or even unsafe therapy instead because the health care system
is a tangled maze.
According Blaisdell, M.D., (1973) explained the problem of lack of emergency room standards, there is
two simultaneous and, in some respect, opposed problems in delivery of emergency services. These are
the lack of adequate emergency facilities in rural areas and, simultaneously, the plethora of inadequate
emergency facilities in metropolitan centers. The problem of economics make the cost of optimal
geographic dispersion of emergency units impractical, and without federal or state funds, many rural
areas will be inadequately served by emergency facilities. The problem of hospital economics, the
plethora of bed in metropolitan hospital as a result of overbuilding has led hospital administrators to
open emergency rooms in an attempt to solicit patients. It must be obvious that if we have situation
such as one another have all opened emergency rooms, the quality of any one emergency room must be
far less adequate than if all the resources were put in one central emergency unit. This situation has
resulted in hospitals developing emergency rooms with no blood bank, x-ray, no oprating facilities, lack
of personnel well-verse an emergency room care, and with no capability for major resuscitation.
A study conducted of Harvard School of Medicine (2018) says that for a wide range of treatable
conditions, 45,000 people die each year due to a lack of health insurance and therefore a lack of access
to ongoing medical care. This seems so obvious that there is no need for documentation, but such
studies are still very important. According to a study published online (2018) by the American Journal of
Public Health, almost 45,000 annual deaths are associated with lack of health insurance. This figure is
approximately two and a half times higher than the 2002 Institute of Medicine (IOM) estimate. The
study, conducted at Harvard Medical School and Cambridge Health Alliance, found that uninsured
working-age Americans have a 40 percent higher risk of death compared to their private insured
counterparts, up from an
excessdeathrateof25percentfoundin1993.Uninsured persons have a higher risk of death compared to pri
vate insured persons, even if they take account of socioeconomics, health behaviors and basic health
. https://fee.org/articles/if-american-healthcare-kills-european-healthcare-kills-more/Consider the best

estimates of how many people die in the US due to a lack of healthcare. The question is hotly contested,
and approximations range from 0 to 45,000 people per year. The latter figure is obviously what most
progressives prefer to cite, and although there’s much to doubt about this number, let’s for the sake of
argument accept that approximately 45,000 fewer people would die in the US every year if all Americans
had decent health insurance. A study by the Fraser Institute titled The Effect of Wait Times on Mortality
in Canada estimated that “increases in wait times for medically necessary care in Canada between 1993
and 2009 may have resulted in between 25,456 and 63,090 (with a middle value of 44,273) additional
deaths among females.” Adjusting for the difference in populations (the US has about 9 times as many
people), that middle value inflates to an estimated 400,000 additional deaths among females over a 16
year period. This translates to an estimated 25,000 additional female deaths each year if the American
system were to suffer from increased mortality similar to that experienced in Canada due to increases in
wait times
According to the 2012 Philippines Health Service Delivery Profile, acollaboration between the DOH and t
he World Health Organization (WHO), only 4 of the 17 regions of the country meet the acceptable popul
ation-based hospital bed. Despite the advances cited in previous State of the Nation Addresses (SONAs)
by President Benigno Aquino III, the country's public health care system is marred by problems. The lack
of health workers, the lack of adequate facilities and the remaining barriers to access to health care for
the poor are just some of these problems. According to a paper presented by the Philippines to the
Southeast Asian Nations Association in 2005, there were 658 doctors in the NCR's government hospitals
in 2002, compared to the 85 doctors in CAR and 69 in ARMM. According to data from Social Watch
Philippines, there were 197 private and public hospitals in the NCR in 2004, again a strong contrast to
the 54 hospitals in the CAR and 17 in the ARMM. Angara said access to health care has a significant
impact on the quality of life in the population of a country. For example, while the NCR's infant mortality
rate is eight per 1,000 children below five, the CAR number is more than double, with 20 deaths per
1,000 children. For every thousand babies, the infant mortality rate in ARMM is worse, more than four
times the NCR statistics at 33 deaths. For every thousand babies born in urban areas, twenty-four babies
die, while in rural areas the infant mortality rate is 50% higher: 36 babies die for every thousand live
births.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6140198/Population Health Challenges Among Rural

CommunitiesIn addition to the challenges of recruiting students to train in rural settings, rural physicians
treat patients that tend to be older, sicker, and less well insured. Populations in rural communities are
increasingly elderly; the average age for hospital admissions in rural settings is over 65, and these older
patients comprise one-half of all admissions. In contrast, older patients in urban settings account for just
37 percent of hospital admissions2. Many patients in rural communities also suffer from multiple
chronic diseases and acutely feel the various social determinants of health that impact their well-being
— from social isolation; to lack of access to affordable, nutritious food; to the impact of rural poverty. A
recent large national study found that although those living in rural areas had a lower incidence of
cancer than those living in urban areas, they suffered from higher rates of death. Researchers suggested
that differences in cancer death rates might reflect disparities in access to health care and timely
diagnosis and treatment, as well as behaviors related to tobacco use and obesity7.
In developing countries, health care is often a low priority, although good health is a prerequisite for
economic development. Problems exist but are not tackled in: provision of safe water; sanitary disposal;
balanced diets; rudimentary knowledge of hygienic practices; dirt floors. Villages are often without
water purification methods, and standing taps and bathing and sewage disposal methods present a
constant health hazard. Even when there is an abundance of available food, a well balanced diet may
not be consistently available. Health information is often a combination of traditional beliefs and
popular images created by advertising. Parasitical and bacterial infestations result in chronic illnesses
and subsequent lost of vitality. The scarcity of trained medical personnel, the high cost of treatment,
and the remoteness of medical facilities block preventive efforts and lead to care only in extreme
emergencies.
However, The World Health Organization (WHO) defines as waste from health care facilities, research
facilities, and health laboratories. This health-care waste is classified as non-risk or general health-care
waste, which is comparable to household waste and as hazardous waste, which can pose a variety of
health risks. Dangerous health waste may also include infectious waste, hazardous waste, sharps,
pharmaceutical waste, genetic waste, chemical waste, heavy metal waste, pressurized containers, and
radioactive waste (Chartier et al., 2014). A public health risk is the improper handling of medical waste,
such as infected syringes and needles. In 2000, the WHO reported 21 million hepatitis B (HBV) infections
were caused by infected syringes (32% of all new infections; 2 million hepatitis C (HCV) infections (40%
of all new infections); and at least 260,000 HIV infections (5% of all new infections). Results of a 2002
WHO assessment in 22 developing countries showed that the proportion of health care facilities not
using proper waste disposal methods ranges from 18% to 64% (World Health Organization, 2011).
Health care waste management in the Philippines is a pressing concern. Sañez (2008) submitted a report
on the regional distribution of unregistered hospitals as hazardous waste generators from February 28-
29, 2008 in Singapore to the First Thematic Working Group on Solid and Hazardous Wastes. The report
revealed that there were 1,492 out of 1,719 or 86.79 percent unregistered hospitals in the country.
There are 119 out of 121 or 98.34 percent unregistered hospitals in four provinces in the Northern
Philippines, Ilocos Norte, Ilocos Sur, La Union and Pangasinan. In short, only two (2) were able to register
as a source of hazardous waste.

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CHAPTER 2

REVIEW OF RELATED LITERATURE

GEOGRAPHIC, CLINICIAN SHORTAGE ISSUES

In a study conducted by OECD, the World Bank and the world health organization (WHO)., (2018)said,

. https://fee.org/articles/if-american-healthcare-kills-european-healthcare-kills-more/Consider the best

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6140198/Population Health Challenges Among Rural

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