Background: The enactment of the Philippine Universal Health Care (UHC) Act mandates the formation of Integrated Health Care Provider Networks (IHCPN), linking hospitals and health facilities, which includes government and privately-owned primary care providers. While hospitals and some health facilities are already under government regulation, primary care providers have not been subjected to formal licensing requirements. In this changing service delivery model, the possible impact of three regulatory policy options being considered need to be assessed according to the goal of ensuring that health services remain affordable and are of high quality. Methodology: A multi-method approach to regulatory impact analysis (RIA) systematically assessed three regulatory options: 1) one Department of Health (DOH) license per hospital and health facility (status quo); 2) one DOH license for all public hospitals and health facilities within an IHCPN and another for individual private hospitals and health facilities; and 3) one DOH license per individual hospital and health facility, and one DOH certification issued to individual hospitals and health facilities as part of an IHCPN. Information from literature, documents, focus group discussions, and cost analyses were triangulated. Results: Regulators are faced with two main risks: there is no standard for networked health care delivery that could provide a foundation for regulation, and provider participation is voluntary, which could lower the interest of private providers to integrate. The three regulatory options considered these risks. Option 1 requires the least change in regulatory policy, but is expected to increase costs to regulators due to the expansion of licensing and enforcement work covering primary care providers. Option 2 requires the most change in regulatory policy, but may be the least expensive to enforce, especially if all facilities join a network. This can also be preferred in a setting with existing interlocal health zones, and participation in the network by private providers poses the most challenge. Option 3 is a tiered regulatory set up that projects the highest cost to regulators as a result of both establishing new certification standards and guidelines on top of a wider scope for enforcement. Conclusion This is the first RIA conducted for the Philippine health system, with challenges similar to those experienced in developing countries. Across the three pre-determined regulatory models, the least costly option may not be the easiest to mount and enforce. Implementability appears to be a stronger consideration which seems to be hinged to the option requiring incremental rather than large form of changes.
Philippines ;

OBJECTIVES

The aim of the study is to estimate the cost of breast cancer diagnosis, treatment, and management in the Philippines. Specifically, it aims to identify the resource requirements and interventions related to breast cancer diagnosis, treatment, and management, measure resource volumes (number of units), learn to value resource items (unit costs), and determine the total cost of treatment per disease stage.

METHODS

The study covered nine tertiary hospitals, seven of which were government hospitals and two were private hospitals, with all tertiary hospitals providing breast cancer services and accredited by Philippine Health Insurance Corporation (PHIC or PhilHealth) for the Z-Benefit Package. Interventions and services related to breast cancer included radiographic procedures, laboratory and imaging tests, chemotherapy drugs and medications, medical and surgical supplies, surgical rates (for breast surgery), accommodation, staff time and salary/professional fees, and other procedure fees. The study conducted in 2022, examined cost prices of breast cancer interventions and services from stage 1–3B.

Purposive and convenience sampling were used based on PhilHealth accreditation and willingness of hospitals to participate in the study. The study conducted a focus group discussion with oncologists, radiologists, anesthesiologists, and other health care providers to validate the clinical guideline used and to solicit inputs to the costing design, analysis framework, and tools for data collection. Data collection of financial cost information (charge price) was conducted using a set of costing matrices filled out by the various departments of the hospitals. Costs and median rates were calculated across hospitals on diagnostics and imaging tests, surgery costs of both public and private facilities, medical treatment, and radiotherapy.

RESULTS

Breast MRI, Breast Panel, and Chest CT Scan are the top 3 most expensive diagnostic procedures ranging from PhP 8,102.00 to PhP 9,800.00 per procedure. Surgical procedures for breast cancer at private hospitals and public hospitals showed huge differences in costs. The cost of a cycle of chemotherapy ranges from PhP 596.70 to PhP 3,700.00 per session, while the cost of targeted therapy can cost up to PhP 46,394.21 per session. A year of hormone therapy ranges from PhP 3,276.00 with the use of Tamoxifen, and up to PhP 68,284.00 with Goserelin. Aromatase inhibitors such as Anastrozole and Letrozole cost from PhP 18,000 to PhP 36,000, respectively. Multiple cycles depending on the diagnosis are prescribed per patient and used in combination with other chemotherapy medications or other therapies such as targeted therapy and hormone therapy are usually taken daily up to 5 to 10 years. Conventional radiotherapy can cost up to PhP 88,150.00 covering 28 sessions, CT simulation, and CT planning.

CONCLUSION

This cost study provides relevant information and better perspective on benefit development for the PHIC, policy development for Department of Health on where and how to focus their support for the patient’s financial preparedness to address medical and f inancial catastrophes.

PhilHealth needs to guide the health care providers of their costing method and to develop their own integrated, interoperable, and comprehensive cost data library.

It recommends that the government allocate budget and cover for screening and assessment for earlier stage diagnosis of patients and lower health expenditure costs on cancer treatment.

Human ; Breast Neoplasms ; Drug Therapy ; Chemotherapy ; Mastectomy ; Radiotherapy ; Radiation Therapy