PhilHealth Supporting the Thrust for Universal Health Care through Data, Information, and
Knowledge Exchange Systems (PhilHealth STUDIES)
The PhilHealth STUDIES is a partnership between the Department of Science and Technology-Philippine Council for Health Research and Development (DOST-PCHRD) and the Philippine Health Insurance Corporation (PhilHealth) initiated to carry-out the PhilHealth Research Agenda centered on generating knowledge for health policy reform and to support the implementation of the Universal Health Care Law. Under the program, the DOST-PCHRD implements the activities for research studies, research utilization, and capacity building that support the PhilHealth research agenda.
PhilHealth STUDIES Projects:
1. Technical Assistance on the Development of Rehabilitation Packages for Adults (18 years old and above) in the Philippines
Implementing Agency: Physicians for Peace Philippines
Cooperating Agency: Philippine Council for Health Research and Development & Philippine Health Insurance Corporation
TECHNICAL ABSTRACT
Rehabilitation is “a set of interventions designed to optimize functioning and reduce disability in individuals with health conditions’’ (WHO, 2018). The recent Philippine Burden of Disease study included diseases that result in heavy burden of care, loss of economic productivity, and poor quality of life -- including ischemic heart disease, hemorrhagic stroke, low back pain, and diabetes mellitus (Epimetrics, 2017). All these conditions require good rehabilitation services to restore productivity, improve quality of life, and manage complications. The Philippine Health Insurance Corporation (PhilHealth), the Philippine’s service purchaser for the provision of health services, previously developed rehabilitation medicine packages. These are, however, limited to inpatient case rates for cardiac rehabilitation and stroke, and outpatient care packages for Children with Disabilities. This project aims to improve health outcomes, quality of life and productivity of adult Filipinos (18 years and above) who will need rehabilitation services through financial risk protection.
This study is divided into three streams of work: 1) Evidence Synthesis and Standards Setting; 2) Costing Analysis; 3) Epidemiologic Analysis. The Evidence Synthesis and Standards Setting is focused on the review of the practice of rehabilitation medicine in the Philippines to determine interventions and services that are proposed for inclusion in the benefit packages for rehabilitation services. The Costing Analysis aimed to determine the various costs in the provision of the services. The Epidemiologic Analysis aimed to identify the epidemiological data of diseases requiring rehabilitation services to determine the potential users of benefit packages.
Evidence Synthesis developed the pathway of care and menu of services for the provision of rehabilitation medicine services through data triangulation - key informant interviews, focus group discussions, and review of literature. Costing Analysis identified actual costs of professional rehabilitation services, medicines, and supplies in public and private hospitals through surveys across 6 regions nationwide. In the epidemiologic analysis, data from a total of 101 studies were extracted for modelling using WHO DISMOD II.
The proportion of disabled people is rising and now stands at about one billion worldwide. The situation becomes even more alarming with data showing that 80% of these people reside in developing countries. A benefit package for rehabilitation services will serve as a form of financial risk protection for populations vulnerable and affected with some form of disability.
2. Technical Assistance on the Development of Comprehensive
PhilHealth Benefits for Mental Health
Implementing Agency: Alliance for Improving Health Outcomes (AIHO)
Cooperating Agency: Philippine Council for Health Research and Development &
Philippine Health Insurance Corporation
TECHNICAL ABSTRACT
Mental health is defined as the state of well-being, wherein an individual can realize his/her own
potential and live their lives fully. This means that an individual should be able to cope with the
stresses of life, work productively and fruitfully, and contribute to society (World Health Organization, 2013). Thus, disturbances or disorders to mental health and well-being can significantly affect an individual, his/her family and the community, posing emotional, psychological, social and financial burden. Currently, PhilHealth only covers mental health conditions such as dementia, bipolar disorders, schizophrenia and anxiety disorders, under Mental and Behavioral Disorders by in-patient admission case rates, only amounting to
Php 7,800. This project aims to improve health outcomes, quality of life and productivity of Filipinos with mental health conditions through development of comprehensive PhilHealth benefits to ensure financial risk protection.
The project included three main methodologies all of which were completed in 10 months. This study is divided into three streams of work: 1) Evidence Synthesis and Standards Setting; 2) Costing Analysis; and 3) Epidemiologic Analysis. The Evidence Synthesis and Standards Setting aimed to determine priority components of the benefit package, status of mental health services in the Philippines, and key stakeholders and partners in the development and implementation of the benefit packages. The Costing Analysis aimed to determine the direct and indirect costs in the provision of the services. The Epidemiologic Analysis aimed to provide data on the prevalence and incidence of mental health illnesses in the country to inform package development.
The algorithm of care and menu of services for the provision of mental health services were developed through evidence synthesis. The project was done through close coordination with technical officials of PhilHealth and DOH, along with key stakeholders such as professional societies, patient organizations, and health facilities. The team developed benefit packages for mental health which cover emergency services, psychiatric and neurologic services, and mhGAP services. While the development of the benefit packages is a significant milestone in enhancing access to health care, new challenges in implementation exist in ensuring that facilities are capacitated. An important consideration prior to implementation of the benefit packages is contextualization within the mechanisms of the Universal Health Care law, which puts emphasis on stronger primary care services, and financing of services through health care provider networks.
3. Expansion of Social Health Insurance Coverage for Myocardial Infarction in the Philippines
Implementing Agency: Alliance for Improving Health Outcomes
Cooperating Agency: Philippine Council for Health Research and Development & Philippine Health Insurance Corporation
ABSTRACT
Heart diseases are a major cause of mortality in the Philippines. Acute Myocardial Infarction, which includes ST-Elevation Myocardial Infarction (STEMI), has the highest rate of mortality among the cardiovascular diseases with an average mortality rate of 10% based on health facility records in the Philippines. STEMI is a time-sensitive condition that requires prompt diagnosis and treatment to prevent further damage and death to the heart. Currently, only diagnostics, thrombolytics, and angioplasty are partially subsidized through the Philippine Health Insurance Corporation (PhilHealth). Considering the burden of STEMI in the Philippines, there is a need to strengthen financial risk protection for this major cause of death. This paper aims to discuss the development of proposed expansion of social health insurance coverage of the Philippine Health Insurance Corporation for myocardial infarction. Through a review of literature and clinical practice guidelines for myocardial infarction, and a series of consultations with technical experts from professional societies and health facilities, the team developed the pathway of care for STEMI patients. A benefit package was developed covering the necessary services across the continuum of care of STEMI patients: (1) First Medical Contact Phase; (2) Acute Care Phase; and (3) Inpatient Management and Rehabilitation Phase. While the expansion of benefit coverage for ACS is an important step in improving access to care, the study has identified that significant challenges remain in terms of healthcare capacity to provide the necessary services. In view of this, it is important to design a benefit coverage that is responsive to the health needs of the population, while ensuring that it is implementable based on the current capacity of the health sector. Additionally, since benefit packages are envisioned to be integrated into a network-based PhilHealth coverage upon the implementation of Universal Health Care, there should be increased efforts to ensure the establishment of health care provider networks.
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