260666 Overcoming health effects of poverty through insurance: Experience from the Philippines

Wednesday, October 31, 2012 : 9:10 AM - 9:30 AM

Carlo Irwin Panelo, Dr , Department of Clinical Epidemiology, University of the Philippines Manila College of Medicine, Manila, Philippines
Jhiedon Florentino, Mr , University of the Philippines School of Economics, Quezon City, Philippines
Orville Solon, Prof , University of the Philippines School of Economics, Quezon City, Philippines
John Peabody, Dr , Departments of Epidemiology & Biostatistics, Medicine and Health Services, University of California San Francisco and Los Angeles, San Francisco, CA
Background: Few studies document the protective effects of health insurance and quality of care against poverty, particularly randomized studies using objective measures. Methods: We used data from 6069 children in the Quality Improvement Demonstration Study (QIDS) done in 30 district hospitals in the Philippines. To measure the protective effects of insurance, we first divided the population into income deciles based on the Family Income and Expenditure Survey. Multivariate regression analysis was used to estimate the effects of insurance coverage on hemoglobin, C-reactive protein (CRP), stunting and wasting while controlling for age, sex, mother's education, poverty and quality of care. Results: More than half of the children sampled were from the poorest decile and most likely to have abnormal hemoglobin, CRP and anthropometrics. Children with health insurance are more likely to have normal hemoglobin by four percentage points (p=0.00). Children who have mothers with higher education, were less likely to be stunted, wasted, and have positive CRP (p=0.00). Children from insured households are less likely to be stunted (p=0.02) and wasted (p=0.002). Children confined in facilities with higher quality, as defined by passing scores in clinical performance and physician vignettes, are less likely to be wasted (p=0.05),but tend to have abnormal hemoglobin (p=0.00), CRP (p=0.001) and stunting(p=0.00),implying that more severe cases are being admitted. Conclusions: Insurance and higher quality of care can overcome the effects of poverty on selected health outcomes. Interventions that expand coverage and increase quality are critical to improving child health, especially among the poor.

Learning Areas:
Conduct evaluation related to programs, research, and other areas of practice
Public health or related public policy

Learning Objectives:
Demonstrate effects of insurance and quality of care on child health outcomes

Keywords: Health Insurance, Quality of Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a medical doctor with graduate training in Economics. My academic and research interests include health economics, policy and quality of care measurement. I have been doing work in health policy, economics and quality measurement for the past 10 years.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.