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too high so that patients affected are pushed into poverty, a

catastrophic illness results. Thus, a catastrophic illness is

defined as both medically and economically catastrophic

(17).

Yearly, the Philippine Health Insurance Corporation, or

Philhealth, pays about PhP 7 billion in premium payments for

catastrophic diseases categorized as Types C and D (17).

However, support value remains low. Thus, in line with its

goals of financial risk protection for all Filipinos, Philhealth

developed an initial set of benefits that comprehensively

cover catastrophic conditions. The package is called "Z

benefit" because if illnesses are classified from A to Z, those

illnesses that push patients into prolonged hospitalizations

and very expensive treatments would be the last letter, or

the Z illnesses (17).

In July of 2012, Philhealth launched the "Z benefit" for

catastrophic illnesses that will not just cover hospital

expenses, but also ensure totality of care and attainment of

better health outcomes. Initially, the cases identified under

the "Z benefit" are childhood lymphocytic leukaemia, breast

and prostate cancers. The package costs for the complete

treatment of these cases are PhP 210,000 for ALL, and PhP

100,000 each for breast and prostate cancers. These

diseases were initially selected based on identified

conditions that have high or acceptable survival rates after

treatment with locally-validated protocols. Complete

course of chemotherapy for three years is provided for ALL,

including essential laboratory tests, and blood product

support. This increased the support value for the treatment

of childhood leukaemia from the regular benefit package of

only PhP 45,000 yearly.

Philhealth initially partnered with selected reference and

contracted government hospitals nationwide to provide the

Z benefits. Reference hospitals provide technical services

such as the development of a registry hub called the Z

Benefit Information Tracking System (ZBITS) to collect

patient information, monitor the registered Type Z cases,

monitor costs, and set standards of care. On the other hand,

contracted hospitals are any Level 3 and 4 hospitals that

have signed performance commitment and contract to

provide total quality care for the Type Z conditions. The

Philippine Children's Medical Center was designated

reference hospital for childhood ALL, with initially 19

contracted government hospitals (17).

PCMC and MCM assisted Philhealth in the crafting of the

benefit package and the implementing guidelines.

Requirements for this national insurance reimbursement

were: 1) use of any of PSPO-determined standard treatment

protocols; 2) presence of basic structures in collaborating

REGIONAL INITIATIVES

CANCER CONTROL 2015 141

jointly implemented by DOH-NCPAM and PCMC focused on

three major areas: 1) chemotherapy drug selection,

forecasting, procurement and distribution (in collaboration

with the Philippine International Trade Corporation, or

PITC); 2) training of professionals involved in the

multidisciplinary treatment team in each partner hospital in

the national network, and; 3) collection of data that can

guide further planning and strategy development.

DOH-NCPAM ALL Medicines Access Program

The Department of Health - National Center for

Pharmaceutical Access and Management (DOH-NCPAM)

had been created pursuant to RA No 9502, otherwise known

as the "Cheaper Medicines Act of 2008". The Center led in

ensuring a policy environment conducive to universal access

to quality essential medicines by improving health outcomes

using policy instruments and setting strategic directions. It

contributes to improving access to quality essential

medicines by: 1) improving the supply side access to quality

essential drugs; 2) ensuring rational use of drugs by

prescribers, dispensers and patients, and; 3)

institutionalizing transparency and good governance in drug

pricing and procurement (15).

To support its mandate of providing affordable drugs, it

implemented the Medicines Access Program (MAP),

particularly for catastrophic diseases. One of these is drug

support for Acute Lymphoblastic Leukaemia (ALL),

otherwise known as the ALLMAP. In 2010, ALLMAP

provided free chemotherapy drugs to indigent patients in 12

DoH-retained hospitals.

In 2012, it partnered with the Philippine Children's

Medical Center designating it as the lead collaborating

hospital in order to improve implementation efficiency and

enhance capacity of all hospitals receiving NCPAM drug

support for the treatment of childhood cancer (15). The

ALLMAP is now the largest source of affordable (even free)

chemotherapy drugs for paediatric cancer patients, thereby

reducing inequities of care due to financial reasons. By

improving access to chemotherapy drugs by poorer patients,

it reduced abandonment of treatment by patients and

increased survival rates. At the Philippine Children's

Medical Center, treatment abandonment rate decreased

from a baseline of 80% to 10%, and increased survival rate

from a baseline of 16% to 78% (16).

The Philhealth Z-package

A medical catastrophe, like cancer, is a condition or disease

state that can lead to disability or death. When combined

with an economic catastrophe, wherein the cost of care is

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