Costs of hospital care for hypertension in an insured population without an outpatient medicines benefit: an observational study in the Philippines

<p>Abstract</p> <p>Background</p> <p>Hypertension is the number one attributable risk factor for death throughout the world and a major contributor to morbidity, mortality, and increasing health care expenditures in the Philippines. Lack of access to outpatient antihypertensive medicines leads to avoidable disease progression and costly inpatient admissions. We estimated the cost to the Philippine Health Insurance Corporation (PhilHealth), which generally does not cover outpatient medicines, for inpatient care for hypertension and its sequelae.</p> <p>Methods</p> <p>Using PhilHealth inpatient claims for discharges between July 1, 2002 and December 31, 2005, we describe costs to PhilHealth for hospitalizations classified by primary discharge diagnoses into hospitalizations for hypertension; hypertensive heart and/or renal disease; other definite; and other possible consequences of untreated hypertension and assess disease trajectory for patients with more than one admission.</p> <p>Results</p> <p>PhilHealth reimbursed US $56 million for 444,628 hospitalizations for hypertension-related diagnoses incurred by 360,016 patients during 3.5 years; 42% of admissions were for essential or secondary hypertension; 19% for hypertensive heart or renal disease; and 39% for other consequences of untreated hypertension. Among 60,659 patients admitted during the first 18 months of the study with a diagnosis of essential or secondary hypertension, 9% were hospitalized again for treatment of sequelae; older individuals (vs. =< 40 years old), men, dependents (vs. members), and those who were employed (vs. in the private membership category) were more likely to be hospitalized again; as were those whose first admission during the study period was for consequences of hypertension (vs. essential or secondary hypertension).</p> <p>Conclusion</p> <p>Inpatient care for hypertension and its sequelae is expensive. Since many hospitalizations may be avoided with antihypertensive pharmacologic therapy, an outpatient medicines benefit may be one cost-effective policy option for PhilHealth.</p

The 2019 Philippine UHC Act, Pandemic Management and Implementation Implications in a Post-COVID-19 World: A Content Analysis

The 2019 Philippine Universal Health Care Act (Republic Act 11223) was set for implementation in January 2020 when disruptions brought on by the pandemic occurred. Will the provisions of the new UHC Act for an improved health system enable agile responses to forthcoming shocks, such as this COVID-19 pandemic? A content analysis of the 2019 Philippine UHC Act can identify neglected and leverage areas for systems’ improvement in a post-pandemic world. While content or document analysis is commonly undertaken as part of scoping or systematic reviews of a qualitative nature, quantitative analyses using a two-way mixed effects, consistency, multiple raters type of intraclass correlation coefficient (ICC) were applied to check for reliability and consistency of agreement among the study participants in the manual tagging of UHC components in the legislation. The intraclass correlation reflected the individuals’ consistency of agreement with significant reliability (0.939, p \u3c 0.001). The assessment highlighted a centralized approach to implementation, which can set aside the crucial collaborations and partnerships demonstrated and developed during the pandemic. The financing for local governments was strengthened with a new ruling that could alter UHC integration tendencies. A smarter allocation of tax-based financing sources, along with strengthened information and communications systems, can confront issues of trust and accountability, amidst the varying capacities of agents and systems

The population-level impacts of a national health insurance program and franchise midwife clinics on achievement of prenatal and delivery care standards in the Philippines

Objectives Adequate prenatal and delivery care are vital components of successful maternal health care provision. Starting in 1998, two programs were widely expanded in the Philippines: a national health insurance program (PhilHealth); and a donor-funded franchise of midwife clinics (Well Family Midwife Clinics). This paper examines population-level impacts of these interventions on achievement of minimum standards for prenatal and delivery care.Methods Data from two waves of the Demographic and Health Surveys, conducted before (1998) and after (2003) scale-up of the interventions, are employed in a pre/post-study design, using longitudinal multivariate logistic and linear regression models.Results After controlling for demographic and socioeconomic characteristics, the PhilHealth insurance program scale-up was associated with increased odds of receiving at least four prenatal visits (OR 1.04 [95% CI 1.01-1.06]) and receiving a visit during the first trimester of pregnancy (OR 1.03 [95% CI 1.01-1.06]). Exposure to midwife clinics was not associated with significant changes in achievement of prenatal care standards. While both programs were associated with slight increases in the odds of delivery in a health facility, these increases were not statistically significant.Conclusions These results suggest that expansion of an insurance program with accreditation standards was associated with increases in achievement of minimal standards for prenatal care among women in the Philippines.Maternal health Prenatal and delivery care National health insurance program Social franchising Philippines

Text Mining for Patterns and Associations on Functions, Relationships and Prioritization in Services Reflected in National Health Insurance Programs

The new Philippine Universal Health Care (UHC) Act was adopted in February 2019 and was slated for implementation in January 2020. However, the ongoing pandemic has thrown the national health insurance program under close scrutiny as the single biggest source of funding for hospitalization or personal health care. An inductive study using text analysis is utilized to discover implementation patterns over time of the national health insurance program’s (NHIP) policies extracted as functions and relationships in publicly issued executive circulars. Standard text mining methods were used to extract publicly available PhilHealth Circulars from 2000–2020. Principal component analysis was used to determine clusters per time period, where time period covered years served each administration from 2000–2020. Result of PCA was used to determine functions. Within each cluster, frequent pattern algorithm (FP growth) was used to determine words that are most frequently associated with each other. This methodology was used to determine policy focus on the following services: membership, benefits, contributions, collection, and accreditation. Results indicate that the first four periods prioritized on accreditation while the remaining three periods focused on membership and benefits. The results also suggest insights on the use of text mining on policy-settings, on change trajectories, if any, and implications for the implementation of the new UHC Act

Assessing the burden of pneumonia using administrative data from Malaysia, Indonesia, and the Philippines

Objectives: To describe the incidence, mortality, cost, and length of stay (LOS) of hospitalized community-acquired pneumonia (CAP) and hospital-acquired pneumonia (HAP) in three Southeast Asian countries: Malaysia, Indonesia, and the Philippines. Methods: Using Casemix system data from contributing hospitals, patients with International Classification of Diseases 10th revision (ICD-10) codes identifying pneumonia were categorized into CAP or HAP using a logical algorithm. The incidence among hospitalized patients, case fatality rates (CFR), mean LOS, and cost of admission were calculated. The population incidence was calculated based on Malaysian data. Results: For every 100 000 discharges, CAP and HAP incidences were 14 245 and 5615 cases, respectively, in the Philippines, 4205 and 2187, respectively, in Malaysia, and 988 and 538, respectively, in Indonesia. The impact was greatest in the young and the elderly. The CFR varied from 1.4% to 4.2% for CAP and from 9.1% and 25.5% for HAP. The mean LOS was 6.1–8.6 days for CAP and 6.9–10.2 days for HAP. The cost of hospitalization was between USD 254 and USD 1208 for CAP and between USD 275 and USD 1482 for HAP. Conclusions: The burden of CAP and HAP is high. Results varied between the three countries, likely due to differences in socio-economic conditions, health system differences, and ICD-coding practices

The 2019 Philippine UHC Act, Pandemic Management and Implementation Implications in a Post-COVID-19 World: A Content Analysis

The 2019 Philippine Universal Health Care Act (Republic Act 11223) was set for implementation in January 2020 when disruptions brought on by the pandemic occurred. Will the provisions of the new UHC Act for an improved health system enable agile responses to forthcoming shocks, such as this COVID-19 pandemic? A content analysis of the 2019 Philippine UHC Act can identify neglected and leverage areas for systems&rsquo; improvement in a post-pandemic world. While content or document analysis is commonly undertaken as part of scoping or systematic reviews of a qualitative nature, quantitative analyses using a two-way mixed effects, consistency, multiple raters type of intraclass correlation coefficient (ICC) were applied to check for reliability and consistency of agreement among the study participants in the manual tagging of UHC components in the legislation. The intraclass correlation reflected the individuals&rsquo; consistency of agreement with significant reliability (0.939, p &lt; 0.001). The assessment highlighted a centralized approach to implementation, which can set aside the crucial collaborations and partnerships demonstrated and developed during the pandemic. The financing for local governments was strengthened with a new ruling that could alter UHC integration tendencies. A smarter allocation of tax-based financing sources, along with strengthened information and communications systems, can confront issues of trust and accountability, amidst the varying capacities of agents and systems