Evidence of a causal link between health outcomes, insurance coverage, and a policy to expand access: experimental data from children in the Philippines

Abstract

In this paper, we present evidence on the health effects of a health insurance intervention targeted to poor children using data from a randomized policy experiment known as the Quality Improvement Demonstration Study (QIDS). Among study participants, using a difference-indifference regression model, we estimated a 9-12 and 4-9 percentage point reduction in the likelihood of wasting and having an infection, as measured by a common biomarker C-reactive Protein, respectively. Interestingly, these benefits were not apparent at the time of discharge; the beneficial health effects were manifest several weeks after release from the hospital.

Health Insurance and Children in Low- and Middle-Income Countries: A Review

“…Seven out of 13 papers are concerned with health insurance expansion for the general population in Burkina Faso (Fink et al, 2013), China (Wagstaff & Yu, 2007;Chen & Jin, 2012), Colombia (Giedion & Uribe, 2009;Miller et al, 2013), Rwanda (Lu et al, 2012), and Thailand (Gruber et al, 2014). Five papers cover health insurance programs targeted at children in the Philippines (Kraft et al, 2009;Quimbo et al, 2011) and Vietnam (Wagstaff & Pradhan, 2005;Nguyen & Wang, 2013;Guindon, 2014;Palmer et al, 2015). It should be noted that one paper (Guindon, 2014) deals with both a program targeted at children and a program for a larger population.…”

“…For instance, in 1992, Egypt introduced its School Health Insurance Programme, which provided free health insurance to children of primary school age (Yip & Berman, 2001). The Philippines expanded insurance coverage among school-age children seeking care in 30 randomly selected treatment sites (Quimbo et al, 2011). In Vietnam, by contrast, school-aged children were included among 'voluntary' insurance target groups yet were strongly encouraged by schools to pay the state-subsidised private premium.…”

What Can Experiments Tell Us About How to Improve Government Performance?

“…In their study of the Primary School Deworming Project in Kenya, for instance, Miguel and Kremer (2004) find that the program not only improved students' health in both treatment schools and neighboring schools, but also reduced school absenteeism by a quarter (although there was no evidence of an effect on academic test scores). In demonstrating the impact of expanded insurance coverage on improved health outcomes among children, Quimbo et al (2011) draw on the Quality Improvement Demonstration Study in the Philippines to show that zero co-payments and increased enrolment were associated after release from the hospital with reduced likelihood of wasting and of having an infection (9-12 and 4-9%, respectively). Kremer et al (2009) evaluate the impact of a merit scholarship program in Kenya in which girls who scored well on exams had school fees paid and received a grant, finding that the program had an effect not only on improved student test scores, but also on teacher attendance.…”

Disparities in Reportable Quality Metrics by Insurance Status in the Primary Spine Neoplasm Population

“…[1][2][3][4][5][6][7][8][9] Although acquiring health insurance may play a role in reducing disparities across socioeconomic groups, [10][11][12] expanding health insurance access does not guarantee that patients receive high quality care. [9,13,14] The Hospital Value Based Purchasing Program, implemented by the Centers for Medicare and Medicaid Services (CMS) as part of the Affordable Care Act (ACA), links healthcare quality with healthcare reimbursements to improve the quality of care received by all patients, regardless of socioeconomic or insurance status.…”