Health conditions, payments, proximity, and opportunity costs: Examining delays in seeking inpatient and outpatient care in the Philippines.

Like other developing countries, the Philippines commits to achieving universal health coverage. To identify the factors - including health care needs, financial and physical access, and opportunity costs - associated with delays in seeking outpatient (OP) and inpatient (IP) care among household members with illness, injury or advised by a doctor, this paper estimates Cox and Weibull proportional hazard models using a nationally-representative sample of households surveyed in 2011, when the Philippine government just started implementing major health reforms. Our results indicate that the delays in seeking OP care tend to be shorter for the very young (5 years old or below), the elderly (65 years old or above), and those with prior poor health. Similarly, delays in seeking IP care tend to be shorter among the very young and those requiring maternity services. Moreover, having a college-educated head of household is associated with shorter delays in seeking OP and IP care. Delays in seeking OP care are shorter in the National Capital Region than in other regions, but longer OP delays are associated with presence of a nearby public health facility. Deferrals in seeking IP care are shorter and delays in seeking OP care are longer when the sick or injured member is employed. When the spouse of the household head is employed, IP care is likewise postponed further. Relative to the poorest income quintile, the second- and third-income quintiles tarry longer. Last, insurance coverage and urban location are not found to be significant correlates. To enhance the effectiveness of recent reforms on utilization, these results suggest deepening the awareness of the covered population of their insurance benefits or to monitor the quality of local health facilities, especially that received grants. Labor policies that reduce the opportunity cost of seeking care among the employed may also be considered.