Economic Burden of Community-Acquired Pneumonia among Adults in the Philippines: Its Equity and Policy Implications in the Case Rate Payments of the Philippine Health Insurance Corporation

Bernadette A. Tumanan-Mendoza, MD, MScCE, MHE1,2, *, Victor L. Mendoza, MD3,4 , Felix Eduardo R. Punzalan, MD, MScCE1,2,5 , Paul Ferdinand M. Reganit, MD, MPH5 , Silverose Ann A. Bacolcol, MD

 

 1 Department of Internal Medicine, Manila Doctors Hospital, Manila, Philippines; 2 Department of Clinical Epidemiology, University of the Philippines College of Medicine, Pedro Gil, Manila, Philippines; 3 Department of Internal Medicine, De La Salle Health Sciences Institute, Dasmarinas, Cavite, Philippines; 4 Department of Physiology, De La Salle Health Sciences Institute, Dasmarinas, Cavite, Philippines; 5 Section of Cardiology, Department of Medicine, University of the Philippines College of Medicine and Philippine General Hospital, Manila, Philippines

ABSTRACT

Objectives: To determine 1) the cost of hospitalization, the 1-week postdischarge cost, the total cost, and the economic burden of community-acquired pneumonia among patients aged 19 years or older in the Philippines and 2) the difference between the estimated costs and the Philippine Health Insurance Corporation (PhilHealth) pneumonia case rate payments. Methods: The study involved two tertiary private hospitals in the Philippines. Using the societal perspective, both health care and non–health care costs were determined. A base-case analysis and sensitivity analyses were performed, and the economic burden of pneumonia was determined using PhilHealth claims. Results: The estimated cost of hospitalization for community-acquired pneumonia-moderate risk (CAP-MR) ranged from Philippine peso (PHP) 36,153 to 113,633 (US $852–2678) and its 1-week postdischarge cost ranged from PHP1450 to 8800 (US $34–207). The cost of hospitalization for community-acquired pneumonia-high risk (CAP-HR) ranged from PHP104,544 to 249,695 (US $2464–5885) and PHP101,248 to 243, 495 (US $2386–5739) using invasive and noninvasive ventilation, respectively. The postdischarge cost for CAPHR ranged from PHP1716 to 10,529 (US $40–248). If only health care cost was considered, the cost ranged from PHP24,403 to 89,433 for CAP-MR and PHP92,848 to 213,395 for CAP-HR. The present PhilHealth case rate payments are PHP15,000 (US $354) and PHP32,000 (US $754) for CAP-MR and CAP-HR, respectively. Based on the number of PhilHealth claims for 2012 and the estimated health care cost, the economic burden of pneumonia in 2012 was PHP8.48 billion for CAP-MR and PHP643.76 million for CAP-HR. Conclusions: The estimated health care cost of hospitalization is markedly higher than the PhilHealth case rate payments. As per the study results, the economic burden of pneumonia is, thus, significantly higher than PhilHealth estimates. Keywords: case rate payments, economic burden, PhilHealth, Philippines, pneumonia.

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