Value-based Health Care Services for Breast Mass Excision Using PhilHealth Case Rate – CM

Value-based Health Care Services for Breast Mass Excision Using PhilHealth Case Rate

Benign Breast Mass 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

Strategies:

  • Outpatient
  • 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 67-year-old patient in whom I excised recently a macrocyst with inspissated contents. The mass was 2.5 cm in size.  The total operating room expense amounted to only P5089.90 (which is P410.10 below the case rate of P5500).  The patient with PhilHealth will not have out-of-pocket payment.  (Note: the hospital earns the P410.10).

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I did not use electrocautery machine.  I just used one absorbable suture for hemostatic suturing as well as for wound closure.  I used only one pack of gauze sponges (10 pieces of 4x4x8).

Postoperatively, I just prescribed Paracetamol 500 mg, one tab right after the operation, then one tab every 4-6 hours as needed for pain.

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.

ROJ@16sept27

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