Health care durations and health care expenses of patients with femoral shaft fractures who underwent intramedullary nailing: retrospective cohort study

ABSTRACT

BACKGROUND@#In 2016, the Philippine Health Insurance Corporation (PhilHealth) introduced the Z-package to provide financial coverage for, among others, intramedullary nailing procedures and implant costs for eligible patients with femoral shaft fractures.@*OBJECTIVE@#To compare health care durations and expenses between patients with closed femoral shaft fractures requiring intramedullary fixation who utilized the PhilHealth Z-package and those who did not. @*DESIGN@#Retrospective cohort study.@*PARTICIPANTS@#66 male and female patients, aged 19 to 39 years, who underwent intramedullary nailing for closed femoral shaft fractures. @*SETTING@#Orthopedic Ward, Southern Philippines Medical Center, Davao City, January to December 2018. @*MAIN OUTCOME PROCEDURE@#Time to surgery, length of hospital stay, total hospital bill, total PhilHealth coverage, other funds for medical assistance (OFMA) coverage, and out-of-pocket (OOP) expenses.@*MAIN RESULTS@#Among the 66 patients, 33 had the Z-package, while the remaining 33 did not. The median time to surgery (19 days vs 24 days; p=0.156), median length of hospital stay (24 days vs 29 days; p=0.546), and median total hospital bill (Php 62,392.00 vs Php 62,404.80; p=0.314) were comparable between those without the Z-package and those who had, respectively. However, patients without the Z-package had significantly lower total PhilHealth coverage (Php 30,740.00 vs Php 48,740.00; p<0.001) and higher OFMA coverage (Php 49,909.90 vs Php 34,409.20; p=0.024), and OOP expenses (Php 0.00; IQR Php 0.00 to Php 20,000.00 vs Php 0.00; IQR Php 0.00 to Php 0.00; p=0.004) compared to those with the Z-package. @*CONCLUSION@#Patients with the Z-package had a slightly longer time to surgery, although this difference was not statistically significant. However, they benefited from significantly lower remaining bills after PhilHealth coverage and reduced OOP expenses compared to patients without Z-package coverage.