Supporting local planning and budgeting for maternal, neonatal and child health in the Philippines.

BACKGROUND: Responsibility for planning and delivery of health services in the Philippines is devolved to the local government level. Given the recognised need to strengthen capacity for local planning and budgeting, we implemented Investment Cases (IC) for Maternal, Neonatal and Child Health (MNCH) in three selected sub-national units: two poor, rural provinces and one highly-urbanised city. The IC combines structured problem-solving by local policymakers and planners to identify key health system constraints and strategies to scale-up critical MNCH interventions with a decision-support model to estimate the cost and impact of different scaling-up scenarios. METHODS: We outline how the initiative was implemented, the aspects that worked well, and the key limitations identified in the sub-national application of this approach. RESULTS: Local officials found the structured analysis of health system constraints helpful to identify problems and select locally appropriate strategies. In particular the process was an improvement on standard approaches that focused only on supply-side issues. However, the lack of data available at the local level is a major impediment to planning. While the majority of the strategies recommended by the IC were incorporated into the 2011 plans and budgets in the three study sites, one key strategy in the participating city was subsequently reversed in 2012. Higher level systemic issues are likely to have influenced use of evidence in plans and budgets and implementation of strategies. CONCLUSIONS: Efforts should be made to improve locally-representative data through routine information systems for planning and monitoring purposes. Even with sound plans and budgets, evidence is only one factor influencing investments in health. Political considerations at a local level and issues related to decentralisation, influence prioritisation and implementation of plans. In addition to the strengthening of capacity at local level, a parallel process at a higher level of government to relieve fund channelling and coordination issues is critical for any evidence-based planning approach to have a significant impact on health service delivery

Analysis of Health Manpower Behavior: Physicians and Dentists

This study analyzes the factors affecting physician and dentist’s productivity and the fees they charge for their clinic services, their willingness to participate in financing schemes and their career decisions. This paper also estimates their average consultation fees and average consultation time using three–stage least squares regression.productivity, health sector, health manpower, consultation fee, physician/medical professions, career decision

Effectiveness of clinic-based cardiovascular disease prevention: A randomized encouragement design experiment in the Philippines

Rationale: Evidence on effectiveness of routine clinic-based cardiovascular disease (CVD) prevention in low- and middle-income countries is lacking. This study aimed to provide evidence on exposure to primary prevention of CVDs obtained through visits to public health clinics in the Philippines that are responsible for operating a widely-adopted CVD risk screening and management protocol. Method: In a 2018 cluster-randomized experiment in Nueva Ecija province, participants aged 40–70 with no history of CVD in randomly selected communities were offered a money-prize lottery ticket if they visited a public health clinic for a check-up. The induced variation in clinic visits was used to estimate effects of a check-up on exposure to CVD prevention indicators (measurement, diagnosis and medication of physiological CVD risk factors, and medical advice about behavioural risk factors), as well as on health behaviour and predicted 10-year CVD risk score. Results: Going for a check-up at a public clinic raised a weighted average of effect sizes of the prevention indicators by 0.16 (95% CI 0.06 to 0.26, FWER-corrected p = 0.0218). Disaggregated analyses revealed positive effects on blood pressure measurement and receipt of medical advice, but no significant effect on diagnosis or medication of either hypertension or diabetes/dyslipidaemia. Despite high baseline prevalence of CVD risk factors and increased receipt of medical advice, there were no significant effects after six months on health behaviour, physiological risk factors or CVD risk score. Conclusion: Getting Filipinos to health clinics responsible for opportunistic CVD risk screening had a muted impact on exposure to CVD prevention and no significant impact on health behaviour and predicted CVD risk. Issuing well-founded protocols may be insufficient to ensure exposure to CVD prevention through routine clinic visits

Filling Potholes on the Road to Universal Health Coverage in the Philippines

The fraction of health-care costs financed from prepayment sources is a critical indicator of progress toward Universal Health Coverage. But it does not tell how prepayment varies with the level of health-care costs and between poorer and richer patients. This paper used survey data from the Philippines to estimate inpatient costs paid by the National Health Insurance Program (aka PhilHealth) in 2013–2017 when attempts were made to extend population, service and financial coverage. The mean fraction of the inpatient bill paid by PhilHealth increased by 21 percentage points. Expansions of population coverage do not appear to have been primarily responsible for this increase. Despite the introduction of a catastrophic cover benefit package, the fraction of inpatient costs that were prepaid increased more at lower costs than at higher costs. PhilHealth payments for inpatient care were pro-rich but became substantially less so, possibly because hospitals were no longer permitted to charge poor patients in excess of reimbursement ceilings. Overall, prepayment of inpatient costs increased and became more pro-poor, reflecting gains in insurance and equity.</p

Household choices, circumstances and equity of access to basic health and education services in the Philippines

In developing countries like the Philippines, a major policy concern is the inequity in access to health and education services. In this paper, we investigate the effects of factors over which households have control ("choices") or none ("circumstances") on their access to basic services. Our logit regression analyses of two nationwide household surveys reveal that household income and composition, mother’s age and education status, and the child’s age and gender are critical. The circumstance factors -- Philhealth coverage and some area-level characteristics of health and education services -- also matter in improving overall access, but not necessarily its equity.Households, equity, health, education, Philippines

A behavioral decomposition of willingness to pay for health insurance

Despite widespread exposure to substantial medical expenditure risk in low-income populations, health insurance enrollment is typically low. This is puzzling from the perspective of expected utility theory. To help explain it, this paper introduces a decomposition of the stated willingness to pay (WTP) for insurance into its fair price and three behavioral deviations from that price due to risk perception and risk attitude consistent with prospect theory, plus a residual. To apply this approach, we elicit WTP, subjective distributions of medical expenditures and risk attitude (utility curvature and probability weighting) from Filipino households in a nationwide survey. We find that the mean stated WTP of the uninsured is less than both the actuarially fair price and the subsidized price at which public insurance is offered. This is not explained by downwardly biased beliefs: both the mean and the median subjective expectation are greater than the subsidized price. Convex utility in the domain of losses pushes mean WTP below the fair price and the subsidized price, and the transformation of probabilities into decision weights depresses the mean further, at least using one of two specific decompositions. WTP is reduced further by factors other than risk perception and attitude

A behavioral decomposition of willingness to pay for health insurance

International audienceAbstract Despite widespread exposure to substantial medical expenditure risk in low-income populations, health insurance enrollment is typically low. This is puzzling from the perspective of expected utility theory. To help explain it, this paper introduces a decomposition of the stated willingness to pay (WTP) for insurance into its fair price and three behavioral deviations from that price due to risk perception and risk attitude consistent with prospect theory, plus a residual. To apply this approach, we elicit WTP, subjective distributions of medical expenditures and risk attitude (utility curvature and probability weighting) from Filipino households in a nationwide survey. We find that the mean stated WTP of the uninsured is less than both the actuarially fair price and the subsidized price at which public insurance is offered. This is not explained by downwardly biased beliefs: both the mean and the median subjective expectation are greater than the subsidized price. Convex utility in the domain of losses pushes mean WTP below the fair price and the subsidized price, and the transformation of probabilities into decision weights depresses the mean further, at least using one of two specific decompositions. WTP is reduced further by factors other than risk perception and attitude

Associations between health-related quality of life and measures of adiposity among Filipino adults

Objective Estimate associations between the health-related quality of life (HRQoL) and adiposity in a low-income population. Methods In a cluster random sample of 3796 Filipinos aged 40–70 years in Nueva Ecija province, we measured body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and six dimensions of HRQoL using the 20-item Short Form Health Survey. We stratified by sex and used nonparametric regression to graph mean HRQoL in each dimension by BMI, WC, and WHR. We used ordinary least squares regression to estimate differences in each HRQoL dimension by categories of BMI, WC, and WHR adjusted for sociodemographic characteristics and smoking. Results Mean HRQoL was lowest for health perception and highest for role functioning. Mean (SD) values of BMI, WC, and WHR were 22.1, 84.8 cm, and 0.9, respectively for males, and 23.7, 86.5 cm, and 0.9, respectively, for females. There was no evidence that higher BMI was associated with lower HRQoL. Adjusted mean social functioning was 4.92 higher for males with high BMI risk compared with acceptable BMI risk. Mean social functioning was 3.61 and 5.48 lower for females with high WC and WHR, respectively, compared with those with low WC and WHR. Mean physical functioning was lower by 2.70 and 1.07 for males and females, respectively, with high compared with low WC. Mean physical functioning was 3.93 lower for males with high compared with low WHR. Mean role functioning was 1.09 and 2.46 lower for males with borderline and high WHR, respectively. Conclusions There is discordance between future adiposity-related health risk and current experience of HRQoL