Effectiveness of the Philippine Health Insurance Corporation Case Rate System for Thyroidectomy in a Tertiary Government Hospital

• Main Authors: Josephine Ann Ramos, Frederick Mars Untalan
• Format: Article
• Language: English
• Published: Philippine Society of Otolaryngology-Head and Neck Surgery, Inc. 2020-05-01
• Series: Philippine Journal of Otolaryngology Head and Neck Surgery
• Subjects: out-of-pocket expenses; thyroidectomy; health care financing; health expenditures; universal health coverage
• Online Access: https://pjohns.pso-hns.org/index.php/pjohns/article/view/1289
• ISSN: 1908-4889; 2094-1501

ABSTRACT Objective: To determine the effectiveness of the Philippine Health Insurance Corporation (PhilHealth) case rate system in reducing out-of-pocket expenses among non-no balance billing (NBB) patients undergoing thyroidectomy under the Department of Otorhinolaryngology – Head and Neck Surgery of the Baguio General Hospital and Medical Center from February to September 2018. Methods: Design: Prospective Cross- Sectional Setting: Tertiary Government Hospital Participants: Sixty-four (64) randomly selected patients with PhilHealth who underwent thyroidectomy who agreed to participate and reveal their statements of accounts Results: Among the study population, 20% belonged to the no balance billing (NBB) category, with zero out-of-pocket expenses during their confinement. Eighty percent (80%) belonged to the non-NBB category and also incurred zero hospital charges. In addition, there was no significant difference in the individual categories of the hospital expenses between the two groups except for the surgical procedures (p= .018, 95% CI). The accumulated total expenses also did not significantly differ between the two groups (p= .063, 95% CI). The minimum amount billed was PhP 1,984.95, while the maximum amount charged was PhP 38,898.65, with a median of PhP 18,703.28 and interquartile range of PhP 4,251.78 (XU: PhP 20,848.74, XL : PhP 16,596.96). There were no reported out-of-pocket expenses from non-NBB patients. The actual cost of thyroidectomy did not differ significantly from the case rate provided by PhilHealth among all the RVS categories. Conclusion: The PhilHealth case rate system is effective in reducing out-of-pocket expenses among non-NBB patients who underwent thyroidectomy in our institution during the study period. Keywords: out-of-pocket expenses; thyroidectomy; health care financing; health expenditures: universal health coverage