A Prospective Study on Direct Out-of-Pocket Expenses of Hospitalized Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease in a Philippine tertiary care center

Abstract

Chronic obstructive pulmonary disease (COPD) is a frequent cause of morbidity and mortality in the Philippines and the majority of the economic burden lies in hospitalizations during an exacerbation. Despite coverage of hospitalization costs with the national health insurance system (PhilHealth) for COPD exacerbations, patients often pay out-of-pocket. This study aimed to determine the demographic characteristics of COPD admissions at a Philippine tertiary care center, Philippine General Hospital, assess the mean cost of hospitalization, and identify predictors of prolonged hospitalization and cost >20,000 Philippine pesos (Php). A prospective cross-sectional study was conducted for 6 months by chart review. Patients were categorized as charity service patients, that is, with no charged professional fees and free medications and private service patients who pay for their health care services. A total of 43 COPD admissions were included. The average daily cost of hospitalization (per 1,000 pesos) for service patients was 4.25, compared to 16 for private service patients. Demographic characteristics and type of accommodation were not significant predictors of prolonged hospital stay nor hospitalization cost of > Php 20,000. Accommodation costs and professional fees accounted for the majority of the overall cost for private patients, while medications and diagnostic tests were the major contributors to the overall cost for charity patients. Despite the existence of PhilHealth, in-patient coverage for COPD remain insufficient. Measures for maximizing COPD control in the outpatient setting could potentially reduce the total cost of this disease.