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Improving access to care for indigent children: increasing enrolment in the PhilHealth Indigent Program

Date: Tuesday 30 October 10.45–12.15
Source: Forum 11
Authors: Stella Quimbo, Associate Professor, Economics, University of the Philippines School of Economics, Philippines
with Kimberly Yee, Orville Solon and John Peabody

Abstract

Studies have shown that access to care is one factor that can lead to improvement in health. However, in developing countries such as the Philippines, access to health care is often restricted, leading to policy efforts focusing on expanding access to health care.

With funding from the National Institutes of Health (NIH), USA, a collaboration of researchers from the University of the Philippines School of Economics and University of San Francisco's Institute for Global Health partnered with the Philippine National Health Insurance Program and the Department of Health to start the Quality Improvement Demonstration Study (QIDS). The purpose of QIDS is to evaluate the impact of policy reforms on the long-term health status of children under the age of five, including their cognitive health status.

Using an experimental design, QIDS randomly assigned expanded coverage in 10 districts of the Visayas region of the Philippines for indigent patients. Expanded insurance coverage in this setting offers a zero co-payment benefit package for all children under five years old. We designated another 10 sites as control sites, in which enrolment was done by usual means through local media sources and word of mouth.

To operationalize the policy change and expand coverage in the 10 intervention sites, we used a simple approach that has proven quite effective. Three members of the QIDS team made regular visits to speak directly with mayors of the local government units. Visits were made in person on a biweekly basis and lasted between 20 and 40 minutes. During each visit dedicated staff discussed enrolment procedures, provided updates, analysed enrolment figures, and presented data related to the benefits of expanded coverage.

We compared the enrolment data between the intervention sites versus the control sites. We found a difference of 29% in enrolment increases from the third quarter of 2005 to the third quarter of 2006 in intervention sites compared to control sites.

In conclusion, QIDS has shown that a simple, individualized marketing effort is an effective approach to increasing enrolment and ultimately, access to care. Moreover, this approach is relatively inexpensive and costs a mere US$ 0.50 for a household of 5 members.