Filipinos face high NCD health costs

Filipinos with non-communicable diseases (NCDs) such as cardiovascular diseases, cancer, and diabetes face significant out-of-pocket health care expenses, according to a recent study by the Philippine Institute for Development Studies (PIDS).

The study, “Determinants of Household Out-of-Pocket Expenditure on Noncommunicable Diseases,” authored by PIDS Consultant Lovely Ann Tolin and PIDS Senior Research Fellow Valerie Gilbert T. Ulep, highlights data from the 2018 National Health Expenditure Survey (NHES).

It is part of the broader three-part PIDS paper, “Analysis of the National Health Expenditure Survey Round 1 and Design of Survey Protocol for NHES Round 2 (Phase 1).”

Tolin explained that several factors influence out-of-pocket spending on NCDs, including the type of health facility, health insurance coverage, presence of comorbidities, and socioeconomic status. This financial burden affects both outpatient and inpatient care, with medications and professional fees being the top cost drivers.

“On an aggregate scale, estimates from the Philippine Statistics Authority showed that NCDs accounted for 30 percent of total health expenditures in 2019,” Tolin said.

“This is a particular concern given that household out-of-pocket expenditures will constitute almost half of total health expenditures due to the lengthy and expensive treatment processes for NCDs,” she added.

These expenses are typically covered by household resources, including savings and income, for both outpatient and inpatient services.

The study found that having Philippine Health Insurance Corporation (PhilHealth) coverage alone does not significantly decrease out-of-pocket spending on NCDs. This may be due to limitations in the PhilHealth benefit package for NCDs, leaving patients financially exposed.

Alternatively, the finding could reflect a demand-side shift, where access to PhilHealth influences healthcare service pricing, leading to a decrease in costs and a subsequent increase in demand for these services.

PhilHealth, represented by Senior Vice President Dr. Renato Limsiaco, Jr., acknowledged these challenges and assured the public of ongoing efforts to expand health insurance coverage and make healthcare services more accessible.

Their goals include exceeding the current 20 percent healthcare financing cap, reducing out-of-pocket expenses, prioritizing primary care services, improving provider payment methods, and strengthening the overall sustainability, digitization, and governance of the healthcare system.

The study also revealed trends in healthcare utilization, showing a preference for hospital outpatient departments over smaller rural health units (RHUs) and health centers. This trend could affect investments in healthcare infrastructure and the integration of local health systems.

Expanding on Tolin’s insights, University of San Carlos Visiting Research Fellow Dr. Alejandro N. Herrin discussed whether this preference for hospital outpatient departments is driven by the breadth of services offered or perceived higher quality of care.

Herrin noted that private health maintenance organizations (HMOs) significantly reduce outpatient spending compared to PhilHealth, likely due to historically limited outpatient benefits under PhilHealth.

These findings raise questions about the effectiveness of current PhilHealth benefit packages and the role of supplementary insurance mandated by the Universal Health Care Act.

The PIDS study recommends several strategies to reduce the financial burden of NCDs. It emphasizes expanding health insurance coverage, improving healthcare service quality, and increasing accessibility through innovative solutions like telemedicine.

Additionally, addressing the limitations of PhilHealth’s NCD benefit package could significantly improve financial protection for patients.

Tolin stressed the importance of early detection through preventive screenings and early treatment initiation to decrease disease progression and reduce preventable hospitalizations. Improving primary healthcare across the Philippines is essential to achieve this goal.