Pricing, Technology Choice, and Information in Health Care Markets

This paper proposes a pricing model for health care markets wherein providers and patients play a Nash bargaining game. In this game, bargaining power is interpreted as a measure of market structure. Thus, marginal cost pricing (monopoly pricing) can be shown as the outcome of the absence of bargaining power among providers (patients). The model is then extended to explain how, in health care markets with imperfect information, discrete technology choices are made by providers and how such choices may drive observed pricing behavior such as price discrimination.health care markets, health care pricing model, health care providers, pricing behavior

Pricing, Technology Choice, and Information in Health Care Markets

This paper proposes a pricing model for health care markets wherein providers and patients play a Nash bargaining game. In this game, bargaining power is interpreted as a measure of market structure. Thus, marginal cost pricing (monopoly pricing) can be shown as the outcome of the absence of bargaining power among providers (patients). The model is then extended to explain how, in health care markets with imperfect information, discrete technology choices are made by providers and how such choices may drive observed pricing behavior such as price discrimination.health care markets, health care pricing model, health care providers, pricing behavior

The Quality Improvement Demonstration Study: An example of evidence-based policy-making in practice

<p>Abstract</p> <p>Background</p> <p>Randomized trials have long been the gold-standard for evaluating clinical practice. There is growing recognition that rigorous studies are similarly needed to assess the effects of policy. However, these studies are rarely conducted. We report on the Quality Improvement Demonstration Study (QIDS), an example of a large randomized policy experiment, introduced and conducted in a scientific manner to evaluate the impact of large-scale governmental policy interventions.</p> <p>Methods</p> <p>In 1999 the Philippine government proposed sweeping reforms in the National Health Sector Reform Agenda. We recognized the unique opportunity to conduct a social experiment. Our ongoing goal has been to generate results that inform health policy. Early on we concentrated on developing a multi-institutional collaborative effort. The QIDS team then developed hypotheses that specifically evaluated the impact of two policy reforms on both the delivery of care and long-term health status in children. We formed an experimental design by randomizing matched blocks of three communities into one of the two policy interventions plus a control group. Based on the reform agenda, one arm of the experiment provided expanded insurance coverage for children; the other introduced performance-based payments to hospitals and physicians. Data were collected in household, hospital-based patient exit, and facility surveys, as well as clinical vignettes, which were used to assess physician practice. Delivery of services and health status were evaluated at baseline and after the interventions were put in place using difference-in-difference estimation.</p> <p>Results</p> <p>We found and addressed numerous challenges conducting this study, namely: formalizing the experimental design using the existing health infrastructure; securing funding to do research coincident with the policy reforms; recognizing biases and designing the study to account for these; putting in place a broad data collection effort to account for unanticipated findings; introducing sustainable policy interventions based on the reform agenda; and providing results in real-time to policy makers through a combination of venues.</p> <p>Conclusion</p> <p>QIDS demonstrates that a large, prospective, randomized controlled policy experiment can be successfully implemented at a national level as part of sectoral reform. While we believe policy experiments should be used to generate evidence-based health policy, to do this requires opportunity and trust, strong collaborative relationships, and timing. This study nurtures the growing attitude that translation of scientific findings from the bedside to the community can be done successfully and that we should raise the bar on project evaluation and the policy-making process.</p

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

Explaining math and science achievement of public school children in the Philippines

This paper presents estimates of an education production function which includes measures of the home learning environment and school inputs recorded at the student level. These are important variables but are often overlooked as a result of data limitations. Results suggest that minimizing teacher absenteeism and effectively providing basic learning materials in schools can improve the math and science achievement of current as well as future generations of students. The home learning environment, including parental education, was found to have a significant effect on student performance.Education production function, Philippines

Should we have confidence if a physician is accredited? A study of the relative impacts of accreditation and insurance payments on quality of care in the Philippines

It is unclear whether health provider accreditation ensures or promotes quality of care. Using baseline data from the Quality Improvement Demonstration Study (QIDS) in the Philippines we measured the quality of pediatric care provided by private and public doctors working at the district hospital level in the country's central region. We found that national level accreditation by a national insurance program influences quality of care. However, our data also show that insurance payments have a similar, strong impact on quality of care. These results suggest that accreditation alone may not be sufficient to promote high quality of care. Further improvements may be achieved with properly monitored and well-designed payment or incentive schemes.Accreditation Quality of care Insurance payment Philippines Physicians Pediatrics

INFORMATION, INCENTIVES AND PRACTICE PATTERNS: THE CASE OF TB DOTS SERVICES AND PRIVATE PHYSICIANS IN THE PHILIPPINES

To explain divergent physician practices, studies focus on either differences in education and training or in financial incentives. The policy challenge is to identify the most cost-effective interventions to encourage adherence to practice guidelines. Utilizing private physician data in major cities in the Philippines, we show the effects of training and financial incentives in physician adoption of the TB DOTS protocol. Training seems to be more important when the new protocol is a significant departure from the old know-how, while financial incentives seem to work better on those who are already clinically competent. These imply that uniform application of information-based and incentive-based interventions may not be cost-effective.Physician practice patterns, physician incentives, practice guidelines, TB DOTS

Household out-of-pocket health spending, health insurance coverage, and children’s school attendance in the Philippines

The microeconomics of family posits that households value and promote the welfare of their members, but given limited resources, their investments in terms of time and money in their children’s health and education and expenditures on other consumption goods are necessarily jointly determined. In this paper, we develop and test a household allocation model that highlights the links between out-of-pocket health spending, health insurance, and schooling decisions. Applying the model on subsamples of households from the 2004 and 2007 Annual Poverty Indicators Survey, we find that insurance coverage with PhilHealth tends to increase the share of health in total expenditures, which in turn reduces the likelihood of school attendance. We also find that PhilHealth coverage has a positive, significant, and independent effect on the likelihood of school attendance. These suggest that the design of social health insurance and other social protection programs, including household-level antipoverty programs, must take into account the joint determination of health, education, and other household decisions to achieve their desired overall impact on household welfare.out-of-pocket health expenditures, health insurance, schooling

An evaluation of the cost-effectiveness of policy navigators to improve access to care for the poor in the Philippines

Objectives Even when health insurance coverage is available, health policies may not be effective at increasing coverage among vulnerable populations. New approaches are needed to improve access to care. We experimentally introduced a novel intervention that uses Policy Navigators to increase health insurance enrollment in a poor population.Methods We used data from the Quality Improvement Demonstration Study (QIDS), a randomized experiment taking place at the district level in the Visayas region of the Philippines. In two arms of the study, we compared the effects of introducing Policy Navigators to controls. The Policy Navigators advocated for improved access to care by providing regular system-level expertise directly to the policy-makers, municipal mayors and governors responsible for paying for and enrolling poor households into the health insurance program. Using regression models, we compared levels of enrollment in our intervention versus control sites. We also assessed the cost-effectiveness of marginal increases in enrollment.Results We found that Policy Navigators improved enrollment in health insurance between 39% and 102% compared to the controls. Policy navigators were cost-effective at 0.86 USD per enrollee. However, supplementary national government campaigns, which were implemented to further increase coverage, attenuated normal enrollment efforts.Conclusion Policy Navigators appear to be effective in improving access to care and their success underscores the importance of local-level strategies for improving enrollment.Policy Health insurance Access Cost-effectiveness Vulnerable populations Social experiment