Evaluation Tool - CON As of April 27 2006

RepublicofthePhilippines

DepartmentofHealth

Regional Office ___

EVALUATIONTOOL

CERTIFICATE OFNEEDFORNEW GENERAL HOSPITALS

Name of Proposed Hospital:

Address of Proposed Hospital:

ProposedBedCapacity: ______

ClassificationAccordingto:

Ownership: ServiceCapability:

[ / ] / Government / [ / ] / Level1 / [ / ] / Level3
[ / ] / Private / [ / ] / Level2

DateofEvaluation:

NotetoEvaluators:

ThefollowingarecoveredbytheCertificateofNeed:EstablishmentofNewGeneral

Hospitals,ConversionofBirthingHomesandSpecialHospitalsintoGeneralHospitals.

ThefollowingareexcludedfromCertificateofNeed:EstablishmentofNewSpecialHospitals includingSanitaria,DNDandPNPHospitals,PenitentiaryHospitals,ResearchHospitals. ThesehospitalsarealsoexcludedfromthecomputationofBed-to-PopulationRatio.

1. BEDTOPOPULATIONRATIO

DeterminationofProjectedPrimaryandSecondaryCatchmentPopulation(P)
BarangayMunicipality/ District/Province/Region / ProjectedPopulation*** (5thyear)ofCatchment Area
PrimaryCatchmentArea*:
SecondaryCatchmentArea/s**:
ProjectedPrimaryandSecondaryCatchmentPopulation(P)=

*PrimaryCatchmentAreareferstothemunicipality/urbandistrictforLevel1 Hospitals,ruraldistrict/cityfor

Level2 Hospitals,provinceand region forLevel3 Hospitals

** SecondaryCatchmentAreareferstoothergeographicareasthathaveaccessorcontiguoustothePrimary

CatchmentArea.

***UseNEDA/NSOPopulationProjection

DeterminationofInventoryHospitalBeds(IHB)inPrimaryandSecondaryCatchment
Areas:
A.ExistingHospitalBeds*
ExistingHospitals / Location / ABC** / LevelofHospital
SubTotalABC(1)
B. HospitalsCurrentlyApplying forLicensetoOperate
Hospitals / Location / ABC / LevelofHospital
SubTotalABC(2)
IHB=TOTALABC= [ABC(1) +ABC(2)] =

*Mayattachadditionalsheetsasneeded

**AuthorizedBedCapacity

DeterminationofBed-to-PopulationRatio (BPR) = IHB / P x1,000
IHB
P
BPR

IfBPRislessthan 1,thefirstcriteriononBed-to-PopulationRatiohasbeenmet.

PleaseproceedtothedeterminationofPBNandUBN,inordertoobtain themaximum numberofbedsthat theproposedhospital mayputup. Thenpleaseproceed totherest ofthe criteria(TravelTime,Accessibility,etc.).

DeterminationofProjectedBedNeed(PBN) = P x 1/1,000
P
PBN
DetermineofUnmetBedNeed (UBN)= PBN-IHB
PBN
IHB
UBN

*UnmetBedNeed = themaximumnumberofbedsthattheproposedhospitalmaybeallowedtoputup.

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IfBPRismorethan 1,proceed tothedeterminationofOccupancyRatesofExisting

Hospitals.

DeterminationofOccupancyRatesofExistingHospitalsinPrimaryandSecondary
CatchmentAreas
ExistingHospitals* / ABC / OccupancyRate
2YearsAgo / AYearAgo / Averageforthe past2yrs.
OverallAverageOccupancy RateofExistingHospitalsforPast2Yrs.:

*Mayattachadditionalsheetsasneeded

Ifaverage occupancyrate ofexistinghospitalsforthepast2yearsislessthan 85%, thefirstcriterion onBed-to-PopulationRatiohasnotbeenmet. Thereforea CertificateofNeedcannot begiventotheproponent.

Iftheaverage occupancyrate ismorethan 85%,thefirstcriteriononBed-to- PopulationRatiohasbeenmet. Pleaseproceedtotherestofthecriteria(Travel Time, Accessibility,etc.).

2. TRAVELTIME

DeterminationofTravel TimefromProposedHospitaltoExistingHospitalsinPrimary andSecondaryCatchmentAreas
ExistingHospitals* / Location / Travel timeto
ProposedHospital

*Mayattachadditionalsheetsasneeded

3. ACCESSIBILITYANDSTRATEGIC LOCATION

AccessibilityandStrategicLocationoftheProposedHospital
Yes / No / Remarks
Accessibility
(Accessiblebytheusualmeansoftransportation duringmostpartoftheyear.)
StrategicLocation

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4. INTEGRATIONWITH PROVINCIALHOSPITALDEVELOPMENTPLAN

IntegrationwithLocal(Provincial)HospitalDevelopmentPlan(ifavailable)
Yes / No / Documentary
Proof/Remarks
ThereisaLocal(Provincial)HospitalDevelopment
PlanthatisapprovedbytheDepartmentofHealth.
TheproposedhospitalisintegratedwiththeLocal
(Provincial)HospitalDevelopmentPlan.

5. TRACK RECORD

DeterminationofTrackRecord
NameofExistingHospital CurrentlyBeingOperated/ ManagedbyProponent,ifany.* / Location / Good complianceto licensing requirements. / Few verified complaints / Remarks
Yes / No / Yes / No

*Mayattachadditionalsheetsasneeded

SUMMARY:

Criteria / Satisfied / Remarks
Yes / No
1. Bed-to-PopulationRatio
2. Travel Time
Atleastonehourawaybytheusualmeansof transportationduringthemostpartofthe
yearfromthenearestexistinghospital)
3. AccessibilityandStrategicLocation
4. Integrationwithlocal(provincial)hospital developmentplan,ifavailable.
5. AcceptableTrackRecord
AllowableNumberofBeds:

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COMMENTS:

RECOMMENDATION:

EVALUATEDBY:

PRINTEDNAMESIGNATUREPOSITION

APPROVEDBY:

DirectorIV

DOH-Regional Office

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