In an effort to revolutionize the country’s orthopedic and rehabilitation services, the Department of Health (DOH) and the Philippine Orthopedic Center (POC) co-hosted the 1st National Orthopedic and Rehabilitation Summit on July 4-5, 2025, at the Bayanihan Center in Pasig City. Under the theme “Strengthening the Referral Systems and Developing Regional Centers for Orthopedic and Rehabilitation Care,” this landmark event gathered leading experts and professionals from both public and private health sectors to align on a shared vision of equitable and decentralized musculoskeletal care.
During the "Optimizing the Referral System" session, key aspects of the Universal Health Care (UHC) framework were dissected. Dr. Michael Caampued, President of the Philippine Society of Public Health Physicians, addressed the critical referral challenges within the UHC context.
Dr. Caampued delivered a presentation to orthopedic surgeons and rehabilitation medicine specialists, highlighting the challenges and opportunities in care integration within the Philippine health system. His insights focused on optimizing referral systems and developing robust regional centers for orthopedic and rehabilitation care under the Universal Health Care (UHC) framework. He underscored that the UHC Act had significant implications for how healthcare was structured and delivered, particularly emphasizing the role of Primary Care Provider Networks (PCPNs) and Health Care Provider Networks (HCPNs). He noted that an effective compensation system and robust cost and quality management were crucial for successful care integration. To illustrate effective care pathways, Dr. Caampued outlined the service level allocation across primary, secondary, and tertiary care for a number of musculoskeletal conditions, highlighting the role of PhilHealth benefits such as the Z-Benefit for orthopedic implants, total hip/knee replacement, spinal cord injuries, stroke, and congenital anomalies, as well as case rates for physical/occupational therapy and pediatric orthopedics.
Dr. Caampued identified several systemic challenges within the healthcare system and proposed actionable recommendations to address them. To combat fragmented care pathways and underutilized gatekeeping providers, he advised formalizing and expanding referral linkages and collaborative agreements with communities and local hospitals, while also increasing "network awareness" among patients regarding available services and assigned healthcare providers to manage demand. Regarding operational and systemic variations and the lack of standardized protocols, Dr. Caampued stressed that the Philippine Orthopedic Center (POC) should serve as the anchor for a national hub-and-spoke model for complex orthopedic and rehabilitation cases. This includes establishing standards, protocols, and clinical pathways from regional to primary care centers, leading capacity-building efforts, investing in workforce development, and disseminating standards nationwide. He also highlighted the importance of identifying Network Key Performance Indicators (KPIs) like surgical conversion and orthopedic intervention rates. Addressing financial and policy barriers, he called for advocating appropriate financing models for Apex Hospitals, ensuring PhilHealth and DOH public financial management rules recognize the unique needs and costs of national specialty centers, and collaborating with these agencies to pilot and scale benefit packages and reimbursement models. To overcome inadequate digital and communication infrastructure, Dr. Caampued emphasized implementing and enforcing standardized Electronic Medical Records (EMRs) and digital referral protocols to ensure efficient and timely patient transfers, prioritizing EMR deployment and interoperability with referring facilities. Finally, to address cultural resistance, organizational inertia, and political tensions, he urged fostering collaboration between the POC and national/local stakeholders to align priorities. He suggested attending to patient-related concerns and provider clamors before engaging them for change, and that paradigm-shifting dialogues, behavior change communication plans, consistency, and sincerity could enhance credibility.
Dr. Caampued concluded his presentation with a powerful message: "No Filipino should have to suffer due to dysfunction, deformity, and disability". His insights are expected to be instrumental in shaping the future of orthopedic and rehabilitation care in the Philippines.
-Nathan Charles Ecarma, MD, MPH