DEVELOPING POLICY RECOMMENDATIONS FOR IMPLEMENTATION OF THE PHIC HYPERTENSION BENEFIT PACKAGE

1. DEVELOPING POLICY RECOMMENDATIONS FOR IMPLEMENTATION OF THE PHIC HYPERTENSION BENEFIT PACKAGE Noel L. Espallardo, MD, MSc Clinical Associate Professor UP College of Medicine and Philippine General Hospital

2. Burden of Illness due to Hypertension • Complications are leading causes of mortality and morbidity • Expensive hospitalizations • Long term need for medications and care giving • Around 10.5 million Filipinos are hypertensive and only 13% are adequately controlled (PHA, 2007)

3. PHIC Claims due to Hypertension • US $56 million for 446,064 hospitalizations for hypertension-related diagnoses between July 2002 and December 2005 (PHIC, 2009) • Reasons for hospital admission • 42% of admissions were for essential or secondary hypertension • 19% for hypertensive heart or renal disease • 39% for other consequences of untreated hypertension

4. Coverage for Outpatient Treatment • Uninsured "patients" had only a 13% success rate when considering out-of-pocket payment limitations (Blanchard, 2008) • Health insurance coverage benefits the younger and older adults regardless of the drug class prescribed (Blood Pressure Lowering Treatment Trialists' Collaboration, 2008)

5. Challenge to PHIC • Impact to the financial state of PHIC • This challenge can be approach by adopting several principles • cost-effective services for hypertensive patients • health services aligned with the available resources • stewards of public fund

6. Objective • Develop policy recommendations for implementation of PHIC outpatient benefit package for hypertension

7. Study Design • Cross-sectional design and involved a mixture of both quantitative and qualitative methodologies (Antique, Capiz, Iloilo and Southern Leyte) • Four phases • Analysis of PHIC paid claims database for the fiscal years 2005-2007 • Semi-structured interview of stakeholders • Document reviews • Policy workshop

8. Results: PHIC Reimbursements • Iloilo • P 1.3 billion for 153,794 claims of which P 123 million were for hypertension and its related diagnosis at P 8,135 per claim • Capiz at P 6,000.00 per claim • Antique at Php 4,782.00 per claim • Southern Leyte at P 2,251.20 per claim.

9. Health Seeking Behavior of PHIC Members • RHU consultation preference • 93% of sponsored members • 35% of employed members • 63% individually paying members • Private physicians • employed members and individually paying members

10. Consultation Process • 21% having their own apparatus while only 10% are monitored in the private clinics • Commonly prescribed drug • Metoprolol • Nifedipine • Clonidine • Amlodipine

11. Outpatient Benefit for Hypertension • The overall objective of this benefit package is to decrease the burden of illness to the society that is caused by hypertension and its complications. • This will be achieved specifically by: • Enhancing and expanding access • Decreasing the financial burden • Preventing hospital admissions • Improving utilization of the PHIC SP program

12. Who Should Be Covered • PHIC Sponsored Program • giving them priority will give them financial protection to the burden of daily treatment • Expansion to other sectors can be done once PHIC has accumulated enough experience for efficient and smooth implementation of the benefit package

13. Components • Component 1 - Outpatient consultations • Screening and diagnosis • Face to face and one-on-one health education • Lifestyle modification seminars and skills training for patients

14. Components • Component 2 – Laboratory Screening • The following laboratory tests should be done at appropriate intervals but no more than 2 times a year: • FBS • Urinalysis

15. Components • Component 3 – Medicines • Medicines covered are the first line anti-hypertensives • Metoprolol • Captopril • Thiazide • Amlodipine

16. Strategies for Implementation

17. Strategies for Implementation

18. Strategies for Implementation

19. Cost to PHIC

20. Thank You Very Much