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. 2022 Jan:18:100310.
doi: 10.1016/j.lanwpc.2021.100310. Epub 2021 Nov 3.

The Impact of COVID-19 on Hospital Admissions for Twelve High-Burden Diseases and Five Common Procedures in the Philippines: A National Health Insurance Database Study 2019-2020

Jhanna Uy  1   2 , Vanessa T Siy Van  1 , Valerie Gilbert Ulep  2   3 , Diana Beatriz Bayani  4 , Damian Walker  5
Affiliations

The Impact of COVID-19 on Hospital Admissions for Twelve High-Burden Diseases and Five Common Procedures in the Philippines: A National Health Insurance Database Study 2019-2020

Jhanna Uy et al. Lancet Reg Health West Pac. 2022 Jan.

Abstract

Background: The Philippines has the highest cumulative COVID-19 cases and deaths in the Western-Pacific. To explore the broader health impacts of the pandemic, we assessed the magnitude and duration of changes in hospital admissions for 12 high-burden diseases and the utilization of five common procedures by lockdown stringency, hospital level, and equity in patient access.

Methods: Our analysis used Philippine social health insurance data filed by 1,295 hospitals in 2019 and 2020. We calculated three descriptive statistics of percent change comparing 2020 to the same periods in 2019: (1) year-on-year, (2) same-month-prior-year, and (3) lockdown periods.

Findings: Disease admissions declined (-54%) while procedures increased (13%) in 2020 versus 2019. The increase in procedures was caused by hemodialysis surpassing its 2019 utilization levels in 2020 by 25%, overshadowing declines for C-section (-5%) and vaginal delivery (-18%). Comparing months in 2020 to the same months in 2019, the declines in admissions and procedures occurred at pandemic onset (March-April 2020), with some recovery starting May, but were generally not reversed by the end of 2020. Non-urgent procedures and respiratory diseases faced the largest declines in April 2020 versus April 2019 (range: -60% to -70%), followed by diseases requiring regular follow-up (-50% to -56%), then urgent conditions (-4% to -40%). During the strictest (April-May 2020) and relaxed (May-December 2020) lockdown periods compared to the same periods in 2019, the declines among the poorest (-21%, -39%) were three-times greater than in direct contributors (-7%, -12%) and two-times more in the south (-16%, -32%) than the richer north (-8%, -10%). Year-on-year admission declines across the 12 diseases and procedures (except for hemodialysis) was highest for level three hospitals. Compared to public hospitals, private hospitals had smaller year-on-year declines for procedures, because of increases in utilization in lower level private hospitals.

Interpretation: COVID-19's prolonged impact on the utilization of hospital services in the Philippines suggests a looming public health crisis in countries with frail health systems. Through the periodic waves of COVID-19 and lockdowns, policymakers must employ a whole-of-health strategy considering all conditions, service delivery networks, and access for the most vulnerable.

Funding: Open Philanthropy.

Keywords: COVID-19; Hospital inpatient care; Lockdowns; Philippines; Social health insurance claims; healthcare utilization.

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Conflict of interest statement

We declare no competing interests. Data Availability The Supplementary File contains the administrative data underlying our analyses, tables, and figures. Local government income class may be downloaded online https://www.psa.gov.ph/classification/psgc/?q=psgc/search. Updated claims datasets may be requested from PhilHealth through the government's Electronic Freedom of Information program (https://www.foi.gov.ph). Analyses code may be shared upon reasonable request from the corresponding author.

Figures

Figure 1
Figure 1
Monthly number of medical admissions and procedures in PhilHealth-accredited hospitals, 2019-2020
Figure 2
Figure 2
Same-month-prior-year percent changes in healthcare utilization by disease and procedure in PhilHealth-accredited hospitals, 2019-2020
See this image and copyright information in PMC

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