Factors Associated with Out-of-Pocket Expense for Shockwave Lithotripsy in the Philippines: Implications for Health Policy

Abstract

Introduction: Extracorporeal shockwave lithotripsy (ESWL) remains to be a cost-effective strategy for treating patients with urolithiasis. In the Philippines, Philhealth shoulders a portion of medical expenses to minimize out-of-pocket (OOP) payment by its members. However, since the establishment of the case-based payment scheme in 2012, no studies have yet assessed its impact on OOP in ESWL.

Objective: To determine the factors associated with out-of-pocket payment among Filipinos seeking treatment in ESWL centers located in the Philippines

Methods: The study utilized a mixed method sequential explanatory design. Twelve ESWL facilities were purposively selected to represent each facility type and location. A total of 2241 patients who underwent ESWL from January to December 2017 in twelve facilities were included in the quantitative study. For the qualitative portion of the research, focus group discussions and key informant interviews were done.

Results: It was found that 77% of the studied population had to pay OOP for ESWL with a median OOP expense to be Php37,769 ($750) after deductions by PhilHealth, private insurance, and other funding agencies. Factors affecting OOP payment differ by facility location. In Metro Manila, factors associated with OOP payment include facility type and private insurance membership. In Luzon, factors associated are facility type, professional fee, Philhealth membership, and private insurance membership. OOP payment was found to be associated with private insurance membership in Visayas, and professional fee in Mindanao.

Conclusion: A high proportion of urolithiasis patients in the country require out-of-pocket (OOP) payment for ESWL despite the deductions from Philhealth, private insurance, and other supporting organizations. The large variation in ESWL charge by facility and location explains the high variability in OOP payment, especially in Visayas and Mindanao. Factors affecting OOP payment were also found to vary depending on the location of the facility.