Formal compliance versus functional access to diagnostics in the PhilHealth primary care benefit package: a glimpse into a rural health unit in the Philippines

Access to essential diagnostic services is a key component of effective primary health care and universal health coverage. In the Philippines, the Philippine Health Insurance Corporation (PhilHealth) has introduced a primary care benefit package, the Yaman ng Kalusugan Program (YAKAP), which provides capitation-based payments to accredited providers to deliver a defined set of primary care services. Under this scheme, providers are required to offer a set of 15 laboratory and diagnostic tests. However, many primary care facilities, particularly rural health units (RHUs) managed by local government units (LGUs), operate with limited laboratory infrastructure and human resources. This correspondence describes a case from an RHU in the Cordillera Administrative Region (CAR) serving approximately 16,000 people. Of the 15 diagnostic tests required under the YAKAP package, nine are provided through memoranda of agreement with external laboratories located in other municipalities rather than being performed on-site. Patients referred for these diagnostic tests are required to travel approximately one to two and a half hours and incur out-of-pocket transportation costs of about 700 Philippine pesos (US$ 12) per round trip.While such arrangements allow facilities to meet accreditation requirements, they may not ensure timely and affordable access to diagnostics for patients. Strengthening diagnostic capacity within primary care facilities is, therefore, critical. Increasing awareness among LGUs of the importance of diagnostics in PHC may encourage greater investment in laboratory services. In addition, the development of a National Essential Diagnostics List could help clarify which tests should be available at primary care facilities and guide prioritized resource allocation.