Philippine Health Insurance Corporation eyes new insurance package for patients with heart problems
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 completely 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 rate of mortality 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 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.
