Comparative effectiveness of two disparate policies on child health: experimental evidence from the Philippines
| Autor: | Orville Solon, Xylee Javier, Riti Shimkhada, Jhiedon Florentino, Dean T. Jamison, Stella A. Quimbo, John W. Peabody, David Paculdo |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
Quality management
Cost effectiveness Philippines Cost-Benefit Analysis Comparative effectiveness research Pay for performance universal health coverage Insurance Coverage 03 medical and health sciences 0302 clinical medicine Universal Health Insurance Environmental health Health care Per capita Medicine Disability-adjusted life year Humans 030212 general & internal medicine Wasting Reimbursement Incentive Actuarial science business.industry 030503 health policy & services Health Policy pay for performance Child Health Infant Newborn Infant policy experiment Original Articles Health Services Quality Improvement Comparative effectiveness 3. Good health Child Preschool medicine.symptom 0305 other medical science business |
| Zdroj: | Health Policy and Planning |
| ISSN: | 1460-2237 0268-1080 |
| Popis: | Background Should health systems invest more in access to care by expanding insurance coverage or in health care services including improving the quality of care? Comparing these options experimentally would shed light on the impact and cost-effectiveness of these strategies. Methods The Quality Improvement Demonstration Study (QIDS) was a randomized policy experiment conducted across 30 districts in the Philippines. The study had a control group and two policy intervention groups intended to improve the health of young children. The demand-side intervention in QIDS was universal health insurance coverage (UHC) for children aged 5 years or younger, and a supply-side intervention, a pay-for-performance (P4P) bonus for all providers who met pre-determined quality levels. In this paper, we compare the impacts of these policies from the QIDS experiment on childhood wasting by calculating DALYs averted per US$spent. Results The direct per capita costs to implement UHC and P4P are US$4.08 and US$1.98 higher, respectively, compared to control. DALYs due to wasting were reduced by 334,862 in UHC and 1,073,185 in P4P. When adjustments are made for the efficiency of higher quality, the DALYS averted per US$ spent is similar in the two arms, 1.56 and 1.58 for UHC and P4P, respectively. Since the P4P quality improvements touches all patients seen by qualifying providers (32% in UHC versus 100% in P4P), there is a larger reduction in DALYs. With similar programmatic costs for either intervention, in this study, each US$spent under P4P yielded 1.52 DALYs averted compared to the standard program, while UHC yielded only a 0.50 DALY reduction. Conclusion P4P had a greater impact and was more cost-effective compared to UHC as measured by DALYs averted. While expanded insurance benefit ceilings affected only those who are covered, P4P incentivizes practice quality improvement regardless of whether children are insured or uninsured. |
| Databáze: | OpenAIRE |
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