Revised PhilHealth case rates for hospitalization for acute coronary syndrome in the Philippines

Felix Eduardo R Punzalan; Noemi S Pestañ; o; 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

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Revised PhilHealth case rates for hospitalization for acute coronary syndrome in the Philippines

Author: Felix Eduardo R. Punzalan ^{1
,

2} ; Noemi S. Pestaño ¹ ; April Ann A. Bermudez-delos Santos ¹ ; Bernadette A. Tumanan-Mendoza ^{1
,

3} ; Victor L. Mendoza ^{4
,

5} ; Eric Oliver D. Sison ^{1
,

2} ; Karen Amoloza-De Leon ¹ ; Eugenio B. Reyes ^{1
,

2
,

6} ; Nashiba M. Daud ⁷ ; Maria Grethel C. Dimalala-Lardizabal ¹ ; Orlando R. Bugarin ⁶ ; Rodney M. Jimenez ⁶ ; Domicias L. Albacite ^{8
,

9} ; Ma. Belen A. Balagapo ^{10
,

11} ; Elfred M. Batalla ^{12
,

13} ; Jonathan James G. Bernardo ^{14
,

15} ; Helen Ong Garcia ¹⁶ ; Amibahar J. Karim ^{17
,

18} ; Gloria R. Lahoz ^{19
,

20} ; Neil Wayne C. Salces ²¹
Author Information

1. Section of Cardiology, Department of Internal Medicine, Manila Doctors Hospital, Manila, Philippines
2. Division of Cardiovascular Medicine, Department of Internal Medicine, University of the Philippines College of Medicine, Manila Philippines
3. Department of Clinical Epidemiology, University of the Philippines College of Medicine, Manila, Philippines
4. Section of Cardiology, Department of Internal Medicine, De La Salle Medical and Health Sciences Institute, Dasmarinas, Cavite, Philippines
5. Department of Physiology, De La Salle Medical and Health Sciences Institute, Dasmarinas, Cavite,Philippines
6. Philippine Heart Association
7. Department of Medicine, Amaipakpak Medical Center, Marawi City, Philippines
8. Angeles University Foundation Medical Center, Angeles, Pampanga, Philippines
9. Department of Internal Medicine, The Medical City Clark, Mabalacat, Pampanga, Philippines
10. Department of Medicine, Divine Word Hospital, Tacloban City, Leyte, Philippines
11. Department of Internal Medicine, Remedios Trinidad Romualdez Hospital, Tacloban City, Leyte, Philippines
12. Department of Internal Medicine, Davao Doctors Hospital, Davao City, Davao del Sur, Philippines
13. Department of Internal Medicine, Southern Philippines Medical Center, Davao City, Davao del Sur, Philippines
14. Division of Cardiology, Department of Medicine, St. Lukes Medical Center, Quezon City, Philippines
15. Department of Medicine, Ospital ng Makati, Makati City, Philippines
16. Division of Cardiology, Department of Medicine, St Lukes Medical Center, Quezon City, Philippines
17. Internal Medicine Department, Zamboanga Peninsula Medical Center, Zamboanga Sibugay, Philippines
18. Internal Medicine Department, Hospital de Zamboanga, Zamboanga del Sur, Philippines
19. Internal Medicine Department, Metro Vigan Hospital, Ilocos Sur, Philippines
20. Internal Medicine Department, Mariano Marcos Memorial Hospital and Medical Center, Ilocos Norte, Philippines
21. Section of Cardiology, Department of Internal Medicine, Chong Hua Hospital, Cebu City, Philippines
Publication Type:Journal Article
Keywords: case rates; PhilHealth; economic impact
MeSH: Acute Coronary Syndrome
From: Philippine Journal of Cardiology 2022;50(2):16-25
CountryPhilippines
Language:English
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) STelevation 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.
Full text:202411091317566012716_PJC Jul-Dec 2022PJC Vol 50 No 2 final_for upload.pdf