Budget impact analysis of the proposed PhilHealth case rates for acute coronary syndrome in the Philippines

Bernadette A Tumanan-mendoza; Victor L Mendoza; Felix Eduardo R Punzalan; Noemi S Pestañ; o; April Ann A Bermudez-delos Santos; Eric Oliver D Sison; Eugenio B Reyes; Karen Amoloza-de Leon; Nashiba M Daud; Maria Grethel C Dimalala-lardizaba; 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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Budget impact analysis of the proposed PhilHealth case rates for acute coronary syndrome in the Philippines

Author: Bernadette A. Tumanan-Mendoza ^{1
,

2} ; Victor L. Mendoza ^{3
,

4} ; Felix Eduardo R. Punzalan ^{1
,

5} ; Noemi S. Pestaño ¹ ; April Ann A. Bermudez-delos Santos ¹ ; Eric Oliver D. Sison ^{1
,

5} ; Eugenio B. Reyes ^{1
,

5
,

6} ; Karen Amoloza-de Leon ¹ ; Nashiba M. Daud ⁷ ; Maria Grethel C. Dimalala-Lardizaba 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. Department of Clinical Epidemiology, University of the Philippines College of Medicine, Manila, Philippines
3. Section of Cardiology, Department of Internal Medicine, De La Salle Medical and Health Sciences Institute, Dasmarinas, Cavite, Philippines
4. Department of Physiology, De La Salle Medical and Health Sciences Institute, Dasmarinas, Cavite,Philippines
5. Division of Cardiovascular Medicine, Department of Internal Medicine, University of the Philippines College of Medicine, Manila 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
From: Philippine Journal of Cardiology 2022;50(2):26-33
CountryPhilippines
Language:English
Abstract: OBJECTIVE
This study aimed to determine the budget impact of the proposed revised PhilHealth case rate packages for acute coronary syndrome (ACS).
METHODS
This budget impact analysis used the static approach or cost calculator modeling method. The prevalence of hospitalization for coronary artery disease in all PhilHealth-accredited hospitals in the country in 2017 and the data from the ACS registry project of the Philippine Heart Association were used in this study. The study multiplied the present PhilHealth coverage with the number of ACS hospitalization claims to come up with the total cost of ACS hospitalization in the next three years with the assumptions that the eligible population and the ACS PhilHealth case rates will remain constant for these years. The future ACS hospitalization costs were also determined if the proposed case rates were used rather than the current PhilHealth case rates. The cost of re-admissions was considered as savings in hospitalization cost (due to prevention of admissions if the appropriate interventions were given) and were deducted from the future total cost of ACS hospitalizations.
RESULTS
The annual total ACS hospitalization cost using the current case rates was Php 1,134,683,000. Using the proposed case rates, the total hospitalization costs over five years was Php 2,653,019,000 in the first year (proposed case rates implemented to only 20% of the ACS patients) and increased to Php 8,726,364,000 by year 5 (full implementation of the proposed case rates or to 100% of ACS patients). This resulted in a lower incremental cost in the first year of implementation compared with a less gradual implementation over 3 years. The total incremental costs would amount to PHP7.6 billion for full implementation.
CONCLUSION
The study provided the budget impact of the proposed revised ACS case rates. The incremental cost is relatively huge, however the benefits of providing coverage of guidelinedirected therapy including invasive strategies for ACS must be considered.
Full text:202411091335090226026_PJC Jul-Dec 2022PJC Vol 50 No 2 final_for upload.pdf