BackgroundThe Philippines failed to achieve its Millennium Development Goal (MDG) commitment to reduce maternal deaths by three quarters. This, together with the recently launched Sustainable Development Goals (SDGs), reinforces the need for the country to keep up in improving reach of maternal and child health (MCH) services. Inequitable use of health services is a risk factor for the differences in health outcomes across socio-economic groups. This study aims to explore the extent of inequities in the use of MCH services in the Philippines after pro-poor national health policy reforms.MethodsThis paper uses data from the 2008 and 2013 Demographic and Health Survey (DHS) in the Philippines. Socio-economic inequality in MCH services use was measured using the concentration index. The concentration index was also decomposed in order to examine the contribution of different factors to the inequalities in the use of MCH services.ResultsIn absolute figures, women who delivered in facilities increased from 2008 to 2013. Little change was noted for women who received complete antenatal care and caesarean births. Facility deliveries remain pro-rich although a pro-poor shift was noted. Women who received complete antenatal care services also remain concentrated to the rich. Further, there is a highly pro-rich inequality in caesarean deliveries which did not change much from 2008 to 2013. Household income remains as the most important contributor to the resulting inequalities in health services use, followed by maternal education. For complete antenatal care use and deliveries in government facilities, regional differences also showed to have important contribution.ConclusionThe findings suggest inequality in the use of MCH services had limited pro-poor improvements. Household income remains to be the major driver of inequities in MCH services use in the Philippines. This is despite the recent national government-led subsidy for the health insurance of the poor. The highly pro-rich caesarean deliveries may also warrant the need for future studies to determine the prevalence of medically unindicated caesarean births among high-income women.Trial registrationNot applicable.
BackgroundThroughout the world, countries are now leading towards Universal Health Coverage -that is, to ensure everyone get access to needed health services without suffering financial hardship. Aside from the Philippines, several Asian countries have also initiated programs to extend social health insurance for the poor. Increasing access to health services is just one of the many reasons why extending insurance coverage for the poor through government subsidies is becoming a popular policy option for countries with Social Health Insurance (SHI) systems.ObjectivesThe primary objective of this study is to evaluate the initial impact of the 2011 reform in the Philippines which sponsored at least 5.2 million poor Filipinos to the country's National Health Insurance Program (Philhealth). Locally known as Kalusugang Pangkalahatan (KP), the reform hopes to improve maternal health outcomes, including facility-based deliveries, as a strategy to keep up with the MDG 5 targets from which the country is unlikely to achieve.MethodsThe study used a double (DID) and triple differences (DDD) estimator to evaluate the impact of extending insurance for the poor. The model was fitted in a Multiple Linear Regression (MLR) and Hierarchical Linear Regression (HLR) to control for regional differences and urban/rural divide. Data used was derived from two consecutive National Demographic and Health Surveys (NDHS) in 2008 (pre-policy) and 2013 (post-policy).ResultThe results suggest that the recent effort in the Philippines to extend SHI for the poor had no short-term impact on facility-delivery. Exploring factors that hinders use of facility for delivery despite the “insured” status of the poor in a bottom-up perspective should therefore be discussed for future policy development.ConclusionMedium- and long-term evaluation is recommended for thorough policy evaluation and future health policy development.
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