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

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.