3p study: preliminary results of an on-going randomized experiment
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3P Study: Preliminary results of an on-going randomized experiment. JJ Capuno, AD Kraft, SA Quimbo, CAR Tan, Jr., VM Fabella and F Bundoc University of the Philippines. Introduction. The DOH’s Kalusugan Pangkalahatan - PowerPoint PPT PresentationTRANSCRIPT
3P Study: Preliminary results of an on-going randomized
experiment
JJ Capuno, AD Kraft, SA Quimbo, CAR Tan, Jr.,
VM Fabella and F BundocUniversity of the Philippines
Introduction
•The DOH’s Kalusugan Pangkalahatan ▫Enroll about five million poorest families with
PhilHealth, towards universal health insurance coverage by 2015
▫Already 25% of total PhilHealth members•Extending coverage to the near-poor and others
in the informal sector▫As vulnerable to health shocks as the poor▫But their enrollment is voluntary▫Just 17% of total PhilHealth members
Joint PHIC & UPecon Policy Studies• In Oct. 2010, PHIC and UPecon signed MOA to provide policy
inputs to improve the coverage, sustainability, and financial protection aspects of PHIC’s Individually Paying Program. Two policy studies:▫Evaluation of the Remittance By Air payment facility▫Policy experiment – effects of pre-paid premium certificates
on enrollment of selected eligible IP members
• Health Equity and Financial Protection in Asia Project▫Four-year, EU-funded, consortium of ten research
institutions in Europe and East Asian countries▫Objectives: (i) To find evidence on the effect of health
insurance on service utilization & financial protection of the poor and informal sector, and (ii) to inform policy
Intervention: 3P certificate• Front
• Back
Intervention: Information packet
2,945 nationally-representative random sample of households
Treatment sites (n=2242)
Control sites (n=702)
With PhilHealth (n=1187)
W/o PhilHealth – to be offered voucher and info (n= 1053)
Enrolled (used voucher)
Not enrolled (did not use
voucher)
Survey the same 1755 households
BASE-LINE
Feb-Apr
2011
INTER-VEN-TION
Feb – Dec
2011
FOLLOW UP
Jan-Mar 2012
3P cohort diagram In 230 municipalities and
cities, 63 provinces, 15 regions
Baseline: All households, by site*Control sites Treatment sites Test of
proportions(p-value)
Freq. Percent Freq. Percent
Willingness to payBelow 50 pesos
50 pesos and aboveTOTAL
40654685
6.0094.00
100.00
1481,8892,037
7.0093.00
100.00
0.2030.203
Average household income per capita
First quintile Second quintile
Third quintileFourth quintile
Fifth quintileTOTAL
134141149149150723
18.5319.5020.6120.6120.75
100.00
378404429465516
2,192
17.2418.4319.5721.2123.54
100.00
0.4300.5220.5440.7300.121
*Baseline survey, unweighted samples.
Baseline: Eligible households, by site*
Eligible households in control sites
Eligible households in treatment sites
Test of proportions(p-value)Freq. Percent Freq. Percent
Willingness to payBelow 50 pesos
50 pesos and aboveTOTAL
18298316
6.0094.00
100.00
31865896
3.0097.00
100.00
0.1220.122
Annual household income per capita
First quintile Second quintile
Third quintileFourth quintile
Fifth quintileTOTAL
5760716659
313
18.2119.1722.6821.0918.85
100.00
210206212195196
1,019
20.6120.2220.8019.1419.23
100.00
0.3540.6850.4770.4470.880
*Baseline survey, unweighted samples.
Enrolment among 3P certificate holders*
*As of 3 Oct. 2011. Unweighted samples.
Enrolled with PhilHealth Not enrolled in PhilHealth Test of proportions(p-value)
Freq. Percent Freq. Percent
Willingness to payBelow 50 pesos
50 pesos and aboveTOTAL
06262
0.00100.00100.00
23699722
3.1996.81
100.00
0.000.00
Self-Assessed Health Status Poor Fair
GoodVery Good
ExcellentTOTAL
26
24181767
2.998.96
35.8226.8725.37
100.00
1490
370202163839
1.6710.7344.1024.0819.43
100.00
0.4310.6500.1880.6080.241
Average distance frm nearest facility
Less than 15 minutes 15 to 30 minutes31 to 60 minutes
Above 1 hourTOTAL
1616181767
23.8823.8826.8725.37
100.00
188275226149838
22.4332.8226.9717.78
100.00
0.7850.1320.9850.122
Selected SMS replies
“Pan0 p0 yan kng pilyd0 ng baTA sa pngalan ng papa nya,PEr0 hndi p0 kmi kasal, madala q0 paRin ba cla sa pilhlth q0?? “
Sender from South Cotabato
“Gd am regarding sa promo philhealth nyo pinakta na namin sa dumaguete philhealth ofc chek pa nila kc d nila alam upecon hefpa team ng survey d2..gs2 q muna chek ofice if tutoo ba.”
Sender from Negros Oriental
“hindi kopa na file. ang philhealth. form kc gepit pa sd pera. sa ngaun. baka sa june na po!”
Sender from Leyte
“Bkit ngayon po lang kyo sumagot nkadaan na bangka, wla na me masasakyan.”
Sender from Rizal
“K po tapusin lng namin un pag aani ng palay eh registered qu n po tnks po s paalala.”
Sender from Quezon
“si (Name Concealed) ay nakapag enrol na kahapon sa phlhealth CAINTA BRANCH april 28 gmit ang inyong UPECON HEFPA PROJECT salamat po sa inyong ibinigay n pabor sa akin upang maging member ng phl health.”
Sender from Rizal
Next steps
•Tentative result – partial premium subsidies and information packet have only modest impact on PhilHealth enrolment.•Possibly due to high transaction costs of enrolment.
•However, intervention period has to be completed to allow for more 3P certificate holders to enroll. ▫Continue with our text blasts and, in addition, phone calls to
those with landlines. ▫Apply multivariate analysis, apply weights and control for
possible confounding factors to tease out the partial effects of the interventions.