PhilHealth studies new heart attack ‘insurance package’

February 3, 2023 Arlene Rivera 129 views

THE Philippine Health Insurance Corporation commissioned a research study to build the foundation for a new insurance package benefiting patients suffering from acute coronary syndrome (ACS), particularly ST-elevation myocardial infarction (STEMI), commonly known as “heart attack.”

The research project was supported under the PhilHealth Supporting the Thrust for Universal Health Care (UHC) through Data, Information, and Knowledge-Exchange Systems (PhilHealth STUDIES), a joint grant management partnership between PhilHealth and the Philippine Council for Health Research and Development (PCHRD) of the Department of Science and Technology (DOST).

STEMI is a type of heart attack where a coronary artery that supplies oxygen to the heart is entirely or almost completely blocked.

According to health facility records, mortality reports, and published studies in the Philippines, Acute Myocardial Infarction, including STEMI, has the highest mortality rate among cardiovascular diseases in the Philippines.

Implemented by the Alliance for Improving Health Outcomes (AIHO), the project has three main components: 1) generating epidemiologic data on the incidence of STEMI in the Philippines, 2) determining essential health services needed by STEMI patients, and 3) analyzing corresponding costs to deliver these services.

“We, at the DOST-PCHRD, are hoping to see positive outcomes for this undertaking soon,” said Executive Director Jaime Montoya. “If implemented, this will be another testament of health research positively impacting our health systems and lessening the health burdens of Filipinos,” he added.

Based on the review of PhilHealth claims for the acute coronary syndrome (ACS) in 2015-2019, the team estimated around 68-73 ACS claims in every 100,000 population per year.

This number reflects only cases managed and claimed for reimbursement by hospitals and does not include cases that are not referred to hospitals.

The STEMI prototype package was developed to address the burden of cardiovascular diseases in the country, specifically ischemic heart disease.

To identify the services included in the prototype package, the team reviewed current local and international clinical practice guidelines for STEMI patients and held validation consultations with health professionals and health facilities across the country.

Costing and analysis of services, medicines and procedures were done to ensure effectiveness in providing the services.

The package sought to identify services to support the needs of patients across all phases of STEMI from the onset of symptoms, acute care, and interventions, up to rehabilitation.

Among the services included were the 12-Lead electrocardiogram (ECG), percutaneous coronary intervention (PCI), and fibrinolysis.

The package design highlights the urgency to minimize delays between diagnosis and intervention (“door-to-balloon” time) to ensure successful outcomes for STEMI patients. Currently, there are Level 3 hospitals in NCR, Luzon, Visayas, and Mindanao that are ready to provide essential services.

Strengths and challenges towards package implementation were identified e.g., availability of human resources and equipment especially in Level 2 or provincial hospitals.

The research results were presented to an audience of PhilHealth program managers, senior officials, and other research partners last November 2022 during the 6th PhilHealth STUDIES Forum at the Philippine International Convention Center.

The prototype for the new STEMI package is currently undergoing actuarial review and will subsequently undergo policy review, rate-setting, stakeholder engagement, health system networking, and field testing before being implemented in healthcare facilities.

PhilHealth is developing the STEMI package as one of the new benefits in compliance with the Universal Health Care Law, and it is expected to be fully implemented in 2025.

Once approved, the new benefits are expected to lower the out-of-pocket medical expenditures of STEMI patients across the country and improve health outcomes towards universal health care.