Implementation Gaps and Challenges of the Universal Healthcare Act in the Provision of Hemodialysis Services

Abstract

Expanded hemodialysis coverage under the Universal Health Care Act requires effective implementation at the facility level to address patients’ treatment needs and financial concerns. This study examined the perceived implementation of the Act and the challenges encountered in providing and accessing hemodialysis services in Batangas, Philippines. A quantitative descriptive observational design was employed, using structured survey responses from 45 healthcare providers and 64 patients and family members. Data were summarized using frequencies, percentages, and weighted means. Healthcare providers rated implementation as moderately implemented, with a composite mean of 3.19, whereas patients and family members rated it as slightly implemented, with a composite mean of 2.45. Providers reported moderately challenging implementation conditions (2.64), while patients and family members reported slightly challenging conditions overall (2.48). Facility overcrowding was the highest-rated challenge among providers (2.96), whereas delays associated with limited availability of specialized healthcare workers ranked highest among patients and family members (2.77). Out-of-pocket expenses were also among the leading concerns of both groups. These findings indicate differing stakeholder perceptions of implementation, particularly regarding financial protection and operational constraints. The study supports clearer communication of benefit entitlements, transparent billing, improved staffing and scheduling, and more responsive administrative and referral processes. The findings describe perceived implementation gaps and do not establish causal effects of the policy.