Pneumonia Costs PhilHealth At Least P2 Billion Annually

[Terpe]

According to GMA News Network Pneumonia topped the list of 20 illnesses that the Philippine Health Insurance Corp. paid for in claims annually, costing at least 2 billion pesos in 2010, a leading infectious disease specialist said Wednesday.

The ranking is based on the number of claims filed by patients for insurance payments in the government-owned and -controlled corporation. In the first half of 2011 alone, PhilHealth had spent at least 1.2 billion pesos in pneumonia claims, according to Dr. Anna Lisa T. Ong Lim, a pediatrics professor at the University of the Philippines – College of Medicine.

In a news conference, she said pneumonia is one of the top five leading causes of mortality in the Philippines. It is one of the diseases caused by Streptococcus pneumonia or pneumococcus, a type of bacteria that is also responsible for meningitis, sinusitis, and bronchitis.

Lim said it makes “good economic sense” for the government to spend an equivalent amount in claims paid by Philhealth for pneumonia to purchase vaccines that will prevent the disease and save more lives, especially those of children and the elderly.

Among children between 1-5 years old, pneumococcal diseases can lead to death, paralysis, mental retardation, seizures, learning disabilities, and hearing loss, Lim said.

Lulu C. Bravo, also a professor at the UP–College of Medicine, told reporters that pneumococcal diseases account for 4,500 deaths of Filipino children under 5 years old annually, according to World Health Organization studies.

“Pneumonia kills more than 2 million children each year worldwide, more than AIDS, malaria, and measles combined,” Bravo added.

Among the 15 countries with the highest number of childhood pneumonia globally, the Philippines ranks No. 10 with 3 million cases, she said. Number 9 was Congo and number 11 was Afghanistan, Lim said.

“The impact on the economy and health system by pneumonia whether in developed or developing countries is the same,” Lim added.

The Department of Health is expected to start initially vaccinating children of the poorest families within the year, with the campaign expanded in the next two years to cover the entire population.

The DOH’s Expanded Program of Immunization for children under five years old covers the following diseases: BCG, diphtheria, tetanus, pertussis, Hepatitis B, influenza, measles, mumps, rubella, and polio

[Terpe]

For anyone interested Here’s a PhilHealth list of the top 20 illnesses or causes of hospitalizations in the Philippines

and Here’s a PhilHealth list of the 20 highest-costing illnesses in the Philippines

[Doc Alan]

The cost to PhilHealth of pneumonia is interesting, but needs to be explained and put in perspective.
There’s no requirement in the Philippines for causes of death to be medically determined prior to registration, so national statistics for causes cannot always be accurately substantiated.
There are two main types of pneumonia – lobar ( affecting 1 or more lobes ) and broncho pneumonia ( more patchy than lobar ). Bronchopneumonia is a common terminal event in old age both in the Philippines and UK, often complicating other conditions. Streptococcus pneumoniae ( for which there is a vaccine ) is not the only cause of pneumonia. There are other causes – such as measles - and other vaccines. Lung tuberculosis is extremely serious – up to 100 filipinos dying every day from this condition.
However, we do know that cardiovascular diseases are followed by cancers as the most serious diseases, both in Philippines and UK. Lung, breast, and large bowel cancers are common in both countries ; liver relatively much commoner in Philippines. Yet only breast cancer is listed in the top 20 ( see below ). This is presumably because of low prevention awareness and the tendency of Filipinos to seek medical help for cancer too late, if at all. Accidents compete with pneumonia ( including TB ) as the next commonest cause of death.
As for the top 20 illnesses or causes of hospitalisation based on claims - again interesting, but not a true reflection of health in the Philippines. At number 2 is “ chronic renal failure “ - not a disease, but the result of several conditions such as diabetes, high blood pressure, and infections ( chronic nephritis separately listed at 14 ). Numbers 7 and 8 would have been better combined as dengue fever. “ Malignant neoplasm of breast “ means breast cancer, at number 16 the only cancer mentioned – surely not ? “ Viral infection “ – at 20 – is vague. Similar comments apply to the top 20 based on costs – no mention of cardiovascular disease – except possibly as a complication of hypertension, but not specified. Cancer is common and expensive to treat, but it seems PhilHealth only deals with that arising in breast. Influenza and malaria don’t get a mention.
The conclusion that pneumonia is being successfully treated because it’s not the top cause of death is surprising in view of its position at the top of claims and cost to PhilHealth. An expanded programme of vaccination, as planned by the Department of Health, would be welcome if it included all those available ( BCG, Haemophilus Type B, Pneumococcal, Measles ) to reduce cases of pneumonia at a young age ( and Influenza at an older age ).