Geographical and socioeconomic disparities in the use of percutaneous coronary intervention in the Philippines

Shoji and colleagues showed regional variations in the distribution of percutaneous coronary interventions (PCI) centers in Japan. Moreover, there were also disparities in the number of scintigraphy and computed tomography scanners across Japan. Lower availability of scintigraphy scanners was associated with lower preprocedural noninvasive stress testing rates.1Shoji S Yamaji K Sandhu AT et al.Regional variations in the process of care for patients undergoing percutaneous coronary intervention in Japan.Lancet Reg Heal – West Pacific. 2022; 22https://doi.org/10.1016/j.lanwpc.2022.100425Summary Full Text Full Text PDF PubMed Scopus (1) Google Scholar The Philippines, a lower-middle-income archipelagic country in Southeast Asia, also faces the same problem of geographical disparities in the availability of PCI-capable hospitals. Coronary artery disease is the leading cause of death in the Philippines and having access to PCI—geographically or financially—may mean life and death to patients with acute coronary syndrome (ACS). The Philippine Heart Association (PHA) also recommends PCI to improve outcomes among patients diagnosed with ACS. Patients who received PCI had lower in-hospitality mortality (5.6%) than those who only received medical management (9.3%). However, a study in 2017 showed a low revascularization rate on index admission.2Bermudez-delos Santos AAA Tumanan-Mendoza BA Mendoza VL et al.The Epidemiologic Burden of Hospitalization for Coronary Artery Disease Among Adults Aged 19 years and above in the Philippines.Philipp J Cardiol. 2020; : 8-19Google Scholar Access to hospitals with catheterization laboratories is limited in the Philippines. As of 2019, Philippine Heart Association recorded only 49 PCI centers in the Philippines—24 in the National Capital Region, and others distributed in major and highly urbanized cities—13 in Luzon, seven in the Visayas, and five in Mindanao (Figure 1). Outside these cities, there are no PCI centers. Another primary reason for the delay in treatment is financial constraints.3Lazaro VL. 2014 PHA Clinical Practice Guidelines for the Diagnosis and Management of Patients with Coronary Heart Disease.ASEAN Hear J Off J ASEAN Fed Cardiol. 2016; 24: 3Crossref Google Scholar The current cost of PCI in the Philippines ranges from PhP152,000 to PhP387,500 (US$3040 to US$7750), inclusive of admission medication, professional fees, and hospital and operating room use. PhilHealth, the country's national health insurance, offers financial assistance to patients undergoing PCI; however, the cost of the procedure is much higher than the coverage. Based on the 2019 procedure case rate, percutaneous coronary angioplasty is subsidized for PhP30, 300 (US$ 606), which includes both the hospital admission and professional fee.4PhilHealth. List of Procedure Case Rates. 2019. https://www.foi.gov.ph/requests/aglzfmVmb2ktcGhyHAsSB0NvbnRlbnQiD1BILTY0NDcyMDAyMDQ2Ngw. Accessed 9 April 2022.Google Scholar The patient shoulders any excess through their private insurance or as an out-of-pocket (OOP) payment. OOP payment increased by 150% from 2002 to 2012, accounting for 74% of the total household health spending in the country.5Bredenkamp C Buisman LR. Financial protection from health spending in the Philippines: policies and progress.Health Policy Plan. 2016; 31: 919-927Crossref PubMed Scopus (30) Google Scholar The gap between the cost of PCI and financial assistance provided by the national insurance contributes to the high-risk population's reluctance to seek health services. To address these challenges and burdens, we call on the government to make PCI more accessible and affordable for Filipinos. We highlight the need for capacity building of hospitals in the provinces and far-flung areas of the country in providing this service to improve the care of patients with coronary artery disease. The government should also continue expanding health insurance coverage for PCI. We declare no competing interests. This study did not receive funding.