Vol. 50 | No. 2 | July-December 2022 Back

Open Access

Revised PhilHealth Case Rates for Hospitalization for Acute Coronary Syndrome in the Philippines

Felix Eduardo R. Punzalan, Noemi S. Pestaño, April Ann A. Bermudez-delos Santos, Bernadette A. Tumanan-Mendoza, Victor L. Mendoza, Eric Oliver D. Sison, Karen Amoloza-De Leon, Eugenio B. Reyes, Nashiba M. Daud, Maria Grethel C. Dimalala-Lardizabal, Orlando R. Bugarin, Rodney M. Jimenez, Domicias L. Albacite, Ma. Belen A. Balagapo, Elfred M. Batalla, Jonathan James G. Bernardo, Helen Ong Garcia, Amibahar J. Karim, Gloria R. Lahoz, Neil Wayne C. Salces
Dec 2022 DOI 10.69944/pjc.494daba9b1

Abstract

BACKGROUND: Hospitalization for acute coronary syndrome (ACS) has epidemiologic and  economic burden. The coverage for hospitalization in the local setting is much less than the  actual costs. Many patients do not consent to or avail of the optimal and timely management  because of financial challenges. 

OBJECTIVES: The paper aimed to propose revised PhilHealth case rates/packages for ACS,  namely: 1) unstable angina (UA), 2) non–ST-elevation myocardial infarction (NSTEMI), and 3) ST elevation myocardial infarction (STEMI). 

METHODS: A consensus panel was organized to provide inputs such as cost and other matters  pertaining to the revision of the PhilHealth ACS case rates/packages. The results of the cost of  hospitalization of the different ACS conditions derived from a study on hospitalization cost for  ACS were presented to the panel. Several focused group discussions were held afterward for  propositioning new case rates through votation and by nominal group technique, using the costs  from the study as the bases of rate adjustment. 

RESULTS: Final costs agreed upon by the consensus panel for medical management alone  for UA, NSTEMI, and STEMI were adjusted or amended in increments of Php 20,000, (80,000,  100,000, and 120,000, respectively). Thrombolysis of a patient admitted for STEMI increased  the cost to Php 140,000. An additional cost of Php 150,000 was added on top of the cost for  medical management and coronary angiogram for NSTE- ACS for PCI with use of a single stent.  For STEMI, the same category had an additional cost of Php 180,000. For each additional stent  used for all clinical scenarios undergoing PCI, Php 65,000 was added, to cover up to a total of 3  stents. 

CONCLUSION: Based on the consensus process with Philippine Heart Association ACS  panelists, the cost proposed ranges from 80,000 pesos to 530,000 pesos depending on the  clinical scenarios. 

KEYWORDS: case rates, PhilHealth, acute coronary syndrome, economic impact 

References
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