菲律宾成年人社区获得性肺炎的经济负担：其公平性及对菲律宾健康保险公司病例费率支付的政策影响

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.

作者信息

Tumanan-Mendoza Bernadette A, Mendoza Victor L, Punzalan Felix Eduardo R, Reganit Paul Ferdinand M, Bacolcol Silverose Ann A

机构信息

Department of Internal Medicine, Manila Doctors Hospital, Manila, Philippines; Department of Clinical Epidemiology, University of the Philippines College of Medicine, Pedro Gil, Manila, Philippines.

Department of Internal Medicine, De La Salle Health Sciences Institute, Dasmarinas, Cavite, Philippines; Department of Physiology, De La Salle Health Sciences Institute, Dasmarinas, Cavite, Philippines.

出版信息

Value Health Reg Issues. 2015 May;6:118-125. doi: 10.1016/j.vhri.2015.03.003. Epub 2015 May 16.

DOI:10.1016/j.vhri.2015.03.003

PMID:29698182

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 CAP-HR 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.

摘要

目的

1）确定菲律宾19岁及以上社区获得性肺炎患者的住院费用、出院后1周费用、总费用及经济负担；2）估算费用与菲律宾健康保险公司（菲律宾医保）肺炎病例费率支付之间的差异。

方法

该研究涉及菲律宾的两家私立三级医院。从社会角度出发，确定医疗保健和非医疗保健费用。进行了基础病例分析和敏感性分析，并使用菲律宾医保理赔数据确定肺炎的经济负担。

结果

社区获得性肺炎中度风险（CAP-MR）的住院费用估计为36,153比索至113,633比索（852美元至2,678美元），出院后1周费用为1,450比索至8,800比索（34美元至207美元）。社区获得性肺炎高风险（CAP-HR）使用有创和无创通气时的住院费用分别为104,544比索至249,695比索（2,464美元至5,885美元）和101,248比索至243,495比索（2,386美元至5,739美元）。CAP-HR的出院后费用为1,716比索至10,529比索（40美元至248美元）。若仅考虑医疗保健费用，CAP-MR的费用为24,403比索至89,433比索，CAP-HR的费用为92,848比索至213,395比索。目前菲律宾医保针对CAP-MR和CAP-HR的病例费率支付分别为15,000比索（354美元）和32,000比索（754美元）。根据2012年菲律宾医保理赔数量及估算的医疗保健费用，2012年CAP-MR的肺炎经济负担为84.8亿比索，CAP-HR为6.4376亿比索。