Value-based Health Care Services for Breast Mass Excision Using PhilHealth Case Rate
Breast Mass (Fibroadenoma) Excision
PhilHealth Case Rate (Hospital – P5500)
Fit the total expenses of operation to the case rate (P5500) and yet producing good outcomes (no complications) = value-based health care services using PhilHealth Case Rate
- Local anesthesia
- Do not use a lot of “unnecessary” or “luxurious” materials or equipment.
- Avoid using electrosurgical equipment if not necessary.
- Be thrifty with the use of operating room sponges, sutures (one suture), etc.
Below is the actual expense of a patient in whom I excised a fibroadenoma lately. The mass was 3-cm in size. The total operating room expense amounted to only P2626.90. If the biopsy cost is included, the total amount is P2626.90 + P2160.00 = P4786.90 (which is P713 below the case rate of P5500). The patient with PhilHealth will not have out-of-pocket payment. (Note: the hospital earns the P713).
I did not use electrocautery machine. I used the absorbable suture for hemostatic suturing as well as for wound closure. I used only one suture (P335.00).
I used only one pack of gauze sponges (10 pieces of 4x4x8) which costs P54.23.
Postoperatively, I just prescribed Paracetamol 500 mg, one tab right after the operation, then one tab every 4-6 hours as needed for pain. The patient took only a total of 3 tablets after the operation. I did not prescribe antibiotics. Patient took a bath a day after the operation washing her operative wound with plain soap and water. There was no prescription of antiseptic solution application. A clean bra was advised with no need for gauze dressing on the wound (open dressing).
There was no complication postoperatively. She feels very comfortable with the postoperative management regimen. She is happy and satisfied with the whole operative experience.
This is an illustration of value-based health care services for breast mass excision using PhilHealth Case Rate.
It goes without saying that the key contributor to keeping the hospital expenses of a patient within the PhilHealth benefits is the surgeon.
Value-based health care services is basing health care on values where value is defined as the health outcomes achieved that matter to patients relative to the cost of achieving those outcomes.
Improving value requires improving one or more outcomes either without raising costs or lowering costs without compromising outcomes.
Value is achieving the best outcomes at the lowest cost.