PhilHealth Research Articles

Economic Burden of Community-Acquired Pneumonia Among Pediatric Patients (Aged 3 Months to < 19 Years) in the Philippines

Objective1) To determine the hospitalization, follow-up and total costs, and the economic burden of community-acquired pneumonia among pediatric patients aged 3 months to <19 years of age; 2) To compare the estimated cost of hospitalization to the pneumonia case rate payments of the Philippine Health Insurance Corporation (PhilHealth). MethodsUsing the societal perspective, both healthcare and non-healthcare costs were estimated. This was done through two tertiary private hospitals in the Philippines. A base-case and sensitivity analyses were performed using 2012 as the reference year. The PhilHealth claims were the basis for the economic burden. ResultsThe estimated healthcare-related hospitalization cost for PCAP-C was PHP24,332 – 75,409 (US$576 – 1,786). For PCAP-D, it was PHP77,460 – 121,301 (US$1,834 – 2,872) without mechanical ventilation and PHP97,993 – 141,834 if mechanical ventilation was used. These amounts are markedly higher than the PhilHealth case rates of PHP15,000 for PCAP C and PHP32,000 for PCAP D. The post-discharge cost was PHP1,175 – 1,531 for PCAP C and PHP1,275 for PCAP D. The total hospitalization cost were PHP 31,332 – 93,609 for PCAP C and PHP117,103 – 160,944 for PCAP D. The exact economic burden due to pneumonia among the pediatric population was not definitely ascertained due to lack of specific number of PhilHealth claims for this age group. ConclusionsThere is a huge disparity between the PhilHealth case rates for PCAP C and PCAP D and the study results. Hence, the estimated economic burden of hospitalization for pneumonia would be markedly higher.

Epidemiologic burden of hospitalisation for congestive heart failure among adults aged ≥19 years in the Philippines

ObjectivesThe study determined the prevalence of hospitalisation due to congestive heart failure (CHF) among adult patients aged 19 years and above in the Philippines and its 17 regions in 2014....

Outcomes of Kidney Transplantations Under the Philippine Health Insurance Corporation's Type Z Benefit Package at the National Kidney and Transplant Institute, Philippines

BackgroundUnder the Universal Health Care Program of the Department of Health, the Philippine Health Insurance Corporation (PHIC) launched the Case Type Z benefit package for kidney transplantation, providing the largest amount (USD $13,300.00) for any single medical procedure. The objective of this study was to describe under the PHIC Case Type Z Benefit Package for kidney transplantation at the National Kidney and Transplant Institute and kidney transplantation outcomes under this package. MethodsIncluded in the benefit were standard risk recipients between 10 and 70 years of age with at least 1 human leukocyte antigen (HLA) DR match with the donor, panel-reactive antibody (PRA) less than 20%, and absence of donor-specific antibody (DSA). Previous transplantations, malignancy, hepatitis B and C, human immunodeficiency virus (HIV) positivity, cytomegalovirus (CMV) R−/D+, congestive heart failure, and liver cirrhosis were exclusion criteria. Patients were evaluated by a medical social worker according to their family's financial status. ResultsSince June 2012, a total of 261 patients have received the benefit, with 44 under service, 37 with fixed co-pay and 180 with variable co-pay. Of the living donor kidney transplants, 98% had immediate graft function, with 2.3% (6/261) acute rejection rates at 1 year. The total cost of hospitalization was within the benefit for living donor kidney transplants (less than USD 8000.00) but exceeded it in all cases of deceased donor kidney transplants. ConclusionsThe successful use of and excellent outcomes under the Case Type Z benefit demonstrated how collaboration among government agencies, health care providers, and pharmaceutical companies could result in a program that improved the access to health care for Filipino patients with end-stage renal disease.

Economic Burden of Community-Acquired Pneumonia among Adults in the Philippines: Its Equity and Policy Implications in the Case Rate Payments of the Philippine Health Insurance Corporation

ObjectivesTo determine 1) the cost of hospitalization, the 1-week postdischarge cost, the total cost, and the economic burden of community-acquired pneumonia among patients aged 19 years or older in the Philippines and 2) the difference between the estimated costs and the Philippine Health Insurance Corporation (PhilHealth) pneumonia case rate payments. MethodsThe study involved two tertiary private hospitals in the Philippines. Using the societal perspective, both health care and non–health care costs were determined. A base-case analysis and sensitivity analyses were performed, and the economic burden of pneumonia was determined using PhilHealth claims. ResultsThe estimated cost of hospitalization for community-acquired pneumonia-moderate risk (CAP-MR) ranged from Philippine peso (PHP) 36,153 to 113,633 (US $852–2678) and its 1-week postdischarge cost ranged from PHP1450 to 8800 (US $34–207). The cost of hospitalization for community-acquired pneumonia-high risk (CAP-HR) ranged from PHP104,544 to 249,695 (US $2464–5885) and PHP101,248 to 243, 495 (US $2386–5739) using invasive and noninvasive ventilation, respectively. The postdischarge cost for CAP-HR ranged from PHP1716 to 10,529 (US $40–248). If only health care cost was considered, the cost ranged from PHP24,403 to 89,433 for CAP-MR and PHP92,848 to 213,395 for CAP-HR. The present PhilHealth case rate payments are PHP15,000 (US $354) and PHP32,000 (US $754) for CAP-MR and CAP-HR, respectively. Based on the number of PhilHealth claims for 2012 and the estimated health care cost, the economic burden of pneumonia in 2012 was PHP8.48 billion for CAP-MR and PHP643.76 million for CAP-HR. ConclusionsThe estimated health care cost of hospitalization is markedly higher than the PhilHealth case rate payments. As per the study results, the economic burden of pneumonia is, thus, significantly higher than PhilHealth estimates.

PIN45 - Economic Burden of Community-Acquired Pneumonia Among Adults In The Philippines Its Clinical and Policy Implications in the Case Rate Payments of The Philippine Health Insurance Corporation

To determine (1) the cost of hospitalization and 1-week post-discharge, (2) the difference between estimated costs and the Philippine Health Insurance Corporation (PhilHealth) pneumonia case rate payments, and (3) the economic burden of community-acquired pneumonia (moderate and high-risk, CAP-MR and CAP-HR, respectively) among patients aged > 19 years old in the Philippines. The study involved two tertiary private hospitals in the Philippines. Using the societal perspective, out-of-pocket expenses and productivity losses were computed. A base case and sensitivity analyses were performed and the economic burden of pneumonia was determined using Philhealth claims. The estimated cost of hospitalization for CAP-MR was PhP 36,153 - 113,633 (US$852 – 2,678) and the1-week post-discharge cost for CAP-MR was PhP 1,450 – 8,800 (US$ 34 – 207) The cost of hospitalization for CAP-HR was PhP 104,544 – 249,695 (US$2,464 – 5,885) and PhP 101,248 – 243, 495 (US$2,386 – 5,739) with the use of either invasive ventilation or non-invasive ventilation, respectively. The post discharge cost for CAP-HR was PhP 1,716 – 10,529 (US$40 – 248). In comparison, the present PhilHealth case rate payments for CAP-MR is PhP 15,000 (US$354) and PhP 32,000 (US$754) for CAP-HR. Based on the number of PhilHealth claims for the year 2012 and the study results, the economic burden of pneumonia in 2012 was PhP 8.48 billion for CAP-MR and PhP 643.76 million for CAP-HR. The paper reported the hospitalization and follow-up costs of CAP-MR and CAP-HR based on the societal perspective. It showed significant difference from the current case rate payments of the Philippine Health Insurance Corporation.

Integrating Casemix system in to the Philippine social health insurance

The Philippine Health Insurance Corporation (PhilHealth) is a government owned and controlled corporation, established in 1995 and tasked to implement the National Health Insurance Program. Since its inception, PhilHealth has utilized the fee-for-service scheme for majority of inpatient benefits and case payment for selected, mostly outpatient benefits. In 2010, the country elected a new president and Universal Health Care was declared a national agenda. The challenge for PhilHealth was not only to ensure 100% coverage but provide true financial risk protection. One of the identified key strategies was to shift to a new provider payment mechanism that will foster patient empowerment through clear and predictable financial support. In Sept 2011, PhilHealth rolled out the first 23 medical and surgical case rates which accounts for 45% of all cases being reimbursed by PhilHealth the previous years. Rates were determined by assigning weights to previously obtained tariff rates, contracting rates for public and private hospitals and average value per claim for the preceding years. The highest computed rates were identified and used. Along with this, a zero co-payment policy or No Balance Billing policy was instituted. After almost 8 months of implementation, case payment scheme is proving to be the only solution for PhilHealth to ensure member empowerment, cost containment and claims processing efficiency. However, the problem still lies in government not being able to provide the necessary medicines and services that is already included in the case payment package. Despite these challenges, 29 medical and 32 surgical illnesses more will be paid as case rates. This will then account for 85% of cases being reimbursed by PhilHealth until a time that these case rates will be converted to full case mix. The change in payment provider mechanism entails a big paradigm shift for the whole health system. Reform interventions inside the corporation are being done that will truly inform, empower and guide its members. Expansion of benefit packages has started. Information technology infrastructure is in full swing and new engagement processes with providers are being adapted. In the end, universal health care can be achieved by re-awakening the spirit of solidarity among Filipinos, which is the very essence of the National Health Insurance Program.

Economic evaluation for first-line anti-hypertensive medicines: applications for the Philippines.

BackgroundMedicines to control hypertension, a leading cause of morbidity and mortality, are a major component of health expenditures in the Philippines. This study aims to review economic studies for first line anti-hypertensive medical treatment without co-morbidities; and discuss practical, informational and policy implications on the use of economic evaluation in the Philippines.MethodsA systematic literature review was performed using the following databases: MEDLINE, EMBASE, BIOSIS, PubMed, The Cochrane Library, Health Economics Evaluations Database (HEED) and the Centre for Reviews and Dissemination – NHS NICE. Six existing economic analytical frameworks were reviewed and one framework for critical appraisal was developed.ResultsOut of 1336 searched articles, 12 fulfilled the inclusion criteria. The studies were summarized according to their background characteristics (year, journal, intervention and comparators, objective/study question, target audience, economic study type, study population, setting and country and source of funding/conflict of interest) and technical characteristics (perspective, time horizon, methodology/modeling, search strategy for parameters, costs, effectiveness measures, discounting, assumptions and biases, results, cost-effectiveness ratio, endpoints, sensitivity analysis, generalizability, strengths and limitations, conclusions, implications and feasibility and recommendations). The studies represented different countries, perspectives and stakeholders.ConclusionsDiuretics were the most cost-effective drug class for first-line treatment of hypertension without co-morbidities. Although the Philippine Health Insurance Corporation may apply the recommendations given in previous studies (i.e. to subsidize diuretics, ACE inhibitors and calcium channel blockers), it is uncertain how much public funding is justified. There is an information gap on clinical data (transition probabilities, relative risks and risk reduction) and utility values on hypertension and related diseases from middle- and low- income countries. Considering the national relevance of the disease, a study on the costs of hypertension in the Philippines including in-patient, out-patient, out-of-pocket, local government and national government expenditure must be made. Economic evaluation may be incorporated in health technology assessment, planning, proposal development, research, prioritization and evaluation of health programmes. The approaches will vary depending on the policy questions. The information gap calls for building strong economic evaluative capacity in growing economies.

A systems approach to improving maternal health in the Philippines

To examine the impact of health-system-wide improvements on maternal health outcomes in the Philippines. A retrospective longitudinal controlled study was used to compare a province that fast tracked the implementation of health system reforms with other provinces in the same region that introduced reforms less systematically and intensively between 2006 and 2009. The early reform province quickly upgraded facilities in the tertiary and first level referral hospitals; other provinces had just begun reforms by the end of the study period. The early reform province had created 871 women's health teams by the end of 2009, compared with 391 teams in the only other province that reported such teams. The amount of maternal-health-care benefits paid by the Philippine Health Insurance Corporation in the early reform province grew by approximately 45%; in the other provinces, the next largest increase was 16%. The facility-based delivery rate increased by 44 percentage points in the early reform province, compared with 9-24 percentage points in the other provinces. Between 2006 and 2009, the actual number of maternal deaths in the early reform province fell from 42 to 18, and the maternal mortality ratio from 254 to 114. Smaller declines in maternal deaths over this period were seen in Camarines Norte (from 12 to 11) and Camarines Sur (from 26- to 23). The remaining three provinces reported increases in maternal deaths. Making health-system-wide reforms to improve maternal health has positive synergistic effects.

Health technology assessment in the Philippines

The aim of this study was to discuss the development of health technology assessment (HTA) in the Philippines. A new national health insurance program began to be implemented in the Philippines in 1995 after passage of the Health Insurance Act. The program is known as the Philippine Health Insurance Corporation (PhilHealth). HTA was introduced to the Philippines in 1998. PhilHealth began to develop an HTA program subsequently. As a developing country struggling to provide comprehensive health care to all citizens, PhilHealth sees HTA as an essential part of assuring that only effective and cost-effective care is provided for the public sector.

Cost analysis of pneumonia treatment in the Philippines

The objectives of this study were to describe the cost distribution of pneumonia treatment in tertiary hospitals in the National Capital Region (NCR) and to identify variations in costs in order to provide basic information to the Philippine Health Insurance Corporation (PHIC) for quality assurance and policy development. This study focuses on 3861 reimbursement claims, which come from 22 government and 38 private tertiary hospitals. Wide variations of cost existed among the hospitals and among the inpatients. Medicine was the leading expenditure in total costs (38%), second was examinations (27%), third was beds (22%) and the last was doctors fees (13%). The same ranking ocurred for reimbursement by PHIC. The private hospitals were more expensive than the government hospitals, but also more efficient in the length of hospitalization. The member patients spent more and were reimbursed more for clinical practice than the dependent patients. However, there was no difference in the length of hospitalization between member and dependent patients. There was no difference in the length of hospitalization and expenditure between Government Service Insurance System (GSIS) in 1997 and Social Security System (SSS) patients. Clinical guidelines should be effectively implemented and PHIC should contribute more to reduce existing variations, improve cost-effectiveness and the quality of clinical practices.

The Employment Status of Women in Ilocos Sur

Women are indispensable in the quest for development. The increased participation ofwomen in the labor force is monumental to the emerging status of Filipino women. I is appalling however, that they continue to be marginalized in the workplace. This study aimed to do"ment the status of working women in IlocosSur. Specifically, it aimed to .aetermine the profile ofwomen workers in the province, the nature oftheir work, their employment status, the traits needed inperforming their tasks and the gender-related problems that they encounter in the workplace. The two cities of Jlocos Sur namely Vigan and Candon were selectedas the study areas. There were I8 respondents in Wigan City while there were 77 respondents in Candon City. The study used the descriptive research design. Data were gathered through a questionnaire and key informants interview. Findings showed that women workers in Ilocos Sur are relatively young belonging to the age bracket 20-35 years, single and receiving salaries below the minimum wage law ofP 185 per day. In terms of the nature oftheir work, they are mostly employed as clerical, sales andservice workers and holdjobs which can be considered as extension oftheir role as women. They enjoy security oftenure but are required to work beyond eight hours and report even on weekends. Temporary workers however, do not enjoy benefits being enjoyed bypermanent workers such as SSS, Phil Health and other benefits. Women considerpatience, alertness and industry as the most important traits in performing their jobs efficiently. They experience discrimination in the workplace and receive lower salaries than men, promotionfor them is slow and they have nofreedom ofexpression in the workplace. Given the abovefindings, it is therefore recommended that there should be closer monitoring of business establishments to ensure that workers enjoy the benefits provided by law. Sanctions andpenalty should also be imposed on these business establishments denying such benefits to their workers. omen workers should also organize themselves to improve their working conditions. Lastly, further research should be conducted to include other sectors where women workers are employed.