Where does the money go? Assessing the expenditure and income effects of the Philippines' Conditional Cash Transfer Program

Evaluation studies on conditional cash transfers (CCT) in the Philippines found small if not insignificantly different from zero effects on household consumption. We use propensity score matching to examine how recipients made use of the money they received, taking into account possible changes in recipient behavior. We find evidence of crowding in - CCT households receive higher transfers from other domestic sources as a positive spillover from becoming CCT beneficiaries Poor CCT households tend to lower their dissavings while non-poor beneficiaries become less indebted. We also find evidence of lower income, lower wages, and lower work-related expenses

Shocks to Philippine households: Incidence, idiosyncrasy and impact

With their country located in the Pacific Ring of Fire and in the monsoon belt, Philippine households are perennially exposed to natural disasters and calamities. In addition, they face health, economic and sociopolitical risks. Using a nationally representative sample of households, we assess the overall incidence of different shocks, the extent to which they simultaneously affect households in the same area, and their impact. A huge majority of households experience shocks, with the incidence of different shocks being roughly the same for poor and rich households. Natural and economic shocks appear to affect more households simultaneously in the same area than sociopolitical shocks, health shocks and deaths. Health shocks and deaths lead to greater short-term and long-term impacts. Richer households are able to recover better than the poor. We draw some implications for the design and targeting of social health insurance, disaster management and other social protection programs

The effects of term limits and yardstick competition on local government provision of health insurance and other public services: The Philippine case

We investigate the effects of two accountability measures on the decisions of the local governments under decentralization. Using a panel of Philippine municipalities and cities in three election years, we find that term limits have negative but weak effects on the provision of health insurance coverage to poor families and on expenditures on local services. However, yardstick competition (i.e., more subsidized insurance coverage for the poor in neighboring local governments) induces them to cover more poor families, but also reduce other public expenditures. To respond to critiques of health decentralization, our results suggest that the objectives of local politicians can be aligned with those of the health sector. The key insight is the incumbent may extend health insurance coverage like a redistributive transfer to pursue reelection objectives. However, the resulting trade off between subsidized insurance coverage and other public services must be considered

Perks and public provisions: Effects of yardstick competition on local government fiscal behavior in the Philippines

Using a panel dataset from cities and municipalities in the Philippines in 2001, 2004 and 2007, we investigate whether yardstick competitio

Does health insurance coverage or improved quality protect better against out-of-pocket payments? Experimental evidence from the Philippines

This paper explores whether health insurance coverage or improved quality at the hospital level protect better against out-of-pocket payments. Using data from a randomized policy experiment in the Philippines, we found that interventions to expand insurance coverage and improve provider quality both had an impact on out-of-pocket payments. The sample consists of 3121 child-patient patient observations across 30 hospitals either at baseline in 2003/04 or at the follow-up in 2007/08. Compared to controls, interventions that expanded insurance and provided performance-based provider payments to improve quality both resulted in a decline in out-of-pocket spending (21% decline, p-value = 0.061; and 24% decline, p-value = 0.017, respectively). With lower out-of-pocket payments for hospital care, monthly household spending on personal hygiene rose by 0.9 (p-value = 0.026) and 0.6 US$ (p-value = 0.098) under the expanded insurance and provider payment interventions, respectively, amounting to roughly a 40–60% increase relative to the controls. With the current surge for health insurance expansion in developing countries, our study suggests paying increased and possibly, equal attention to supply-side interventions will have similar impacts with operational simplicity and greater provider accountability

Underutilization of Social Insurance among the Poor: Evidence from the Philippines

Many developing countries promote social health insurance as a means to eliminate unmet health needs. However, this strategy may be ineffective if there are barriers to fully utilizing insurance.We analyzed the utilization of social health insurance in 30 hospital districts in the central regions of the Philippines between 2003 and 2007. Data for the study came from the Quality Improvement Demonstration Study (QIDS) and included detailed patient information from exit interviews of children under 5 years of age conducted in seven waves among public hospital districts located in the four central regions of the Philippines. These data were used to estimate and identify predictors of underutilization of insurance benefits--defined as the likelihood of not filing claims despite having legitimate insurance coverage--using logistic regression.Multivariate analyses using QIDS data from 2004 to 2007 reveal that underutilization averaged about 15% throughout the study period. Underutilization, however, declined over time. Among insured hospitalized children, increasing length of stay in the hospital and mother's education, were associated with less underutilization. Being in a QIDS intervention site was also associated with less underutilization and partially accounts for the downward trend in underutilization over time.The surprisingly high level of insurance underutilization by insured patients in the QIDS sites undermines the potentially positive impact of social health insurance on the health of the marginalized. In the Philippines, where the largest burden of health care spending falls on households, underutilization suggests ineffective distribution of public funds, failing to reach a significant proportion of households which are by and large poor. Interventions that improve benefit awareness may combat the problem of underutilization and should be the focus of further research in this area

Cost of hospital management of Clostridium difficile infection in United States - a meta-analysis and modelling study

Background: Clostridium difficile infection (CDI) is the leading cause of infectious nosocomial diarrhoea but the economic costs of CDI on healthcare systems in the US remain uncertain. Methods: We conducted a systematic search for published studies investigating the direct medical cost associated with CDI hospital management in the past 10 years (2005-2015) and included 42 studies to the final data analysis to estimate the financial impact of CDI in the US. We also conducted a meta-analysis of all costs using Monte Carlo simulation. Results: The average cost for CDI case management and average CDI-attributable costs per case were $42,316 (90$ 39,886, $44,765) and$ 21,448 (90 % CI: $21,152,$ 21,744) in 2015 US dollars. Hospital-onset CDIattributable cost per case was $34,157 (90$ 33,134, $35,180), which was 1.5 times the cost of communityonset CDI ($ 20,095 [ 90 % CI: $4991,$ 35,204]). The average and incremental length of stay (LOS) for CDI inpatient treatment were 11.1 (90 % CI: 8.7-13.6) and 9.7 (90 % CI: 9.6-9.8) days respectively. Total annual CDI-attributable cost in the US is estimated US$6.3 (Range:$ 1.9-$ 7.0) billion. Total annual CDI hospital management required nearly 2.4 million days of inpatient stay. Conclusions: This review indicates that CDI places a significant financial burden on the US healthcare system. This review adds strong evidence to aid policy-making on adequate resource allocation to CDI prevention and treatment in the US. Future studies should focus on recurrent CDI, CDI in long-term care facilities and persons with comorbidities and indirect cost from a societal perspective. Health-economic studies for CDI preventive intervention are needed.Sanofi PasteurSCI(E)[email protected]