The population-level impacts of a national health insurance program and franchise midwife clinics on achievement of prenatal and delivery care standards in the Philippines

Kozhimannil, Katy B.; Valera, Madeleine; Adams, Alyce S.; Ross‐Degnan, Dennis

doi:10.1016/j.healthpol.2009.02.009

Cited by 30 publications

(33 citation statements)

References 19 publications

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“…Subgroup analyses in this moderate quality study showed that this health insurance program could reduce inequalities; with the strongest impacts among women in rural areas, those in the lowest wealth tertile and those who were employed [32]. …”

Section: Resultsmentioning

confidence: 99%

What interventions are effective on reducing inequalities in maternal and child health in low- and middle-income settings? A systematic review

et al. 2014

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BackgroundThe deadline for achieving Millennium Development Goals 4 and 5 is approaching, but inequalities between disadvantaged and other populations is a significant barrier for progress towards achieving these goals. This systematic review aims to collect evidence about the differential effects of interventions on different sociodemographic groups in order to identify interventions that were effective in reducing maternal or child health inequalities.MethodsWe searched the PubMed, EMBASE and other relevant databases. The reference lists of included reviews were also screened to find more eligible studies. We included experimental or observational studies that assessed the effects of interventions on maternal and child health, but only studies that report quantitative inequality outcomes were finally included for analysis.Results22 articles about the effectiveness of interventions on equity in maternal and child health were finally included. These studies covered five kinds of interventions: immunization campaigns, nutrition supplement programs, health care provision improvement interventions, demand side interventions, and mixed interventions. The outcome indicators covered all MDG 4 and three MDG 5 outcomes. None of the included studies looked at equity in maternal mortality, adolescent birth rate and unmet need for family planning. The included studies reported inequalities based on gender, income, education level or comprehensive socioeconomic status. Stronger or moderate evidence showed that all kinds of the included interventions may be more effective in improving maternal or child health for those from disadvantaged groups.ConclusionStudies about the effectiveness of interventions on equity in maternal or child health are limited. The limited evidence showed that the interventions that were effective in reducing inequity included the improvement of health care delivery by outreach methods, using human resources in local areas or provided at the community level nearest to residents and the provision of financial or knowledge support to demand side.

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Section: Resultsmentioning

confidence: 99%

What interventions are effective on reducing inequalities in maternal and child health in low- and middle-income settings? A systematic review

et al. 2014

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“…The majority of studies were published in two years, 2003 [20,26-29] and 2009 [17,18,30,31], with five and four studies, respectively. One study was published in each of the following years: 1995 [32], 2004 [33], 2007 [34] and 2008 [35].…”

Section: Resultsmentioning

confidence: 99%

The standard of healthcare accreditation standards: a review of empirical research underpinning their development and impact

Greenfield

Pawsey

Hinchcliff

et al. 2012

BMC Health Serv Res

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BackgroundHealthcare accreditation standards are advocated as an important means of improving clinical practice and organisational performance. Standard development agencies have documented methodologies to promote open, transparent, inclusive development processes where standards are developed by members. They assert that their methodologies are effective and efficient at producing standards appropriate for the health industry. However, the evidence to support these claims requires scrutiny. The study’s purpose was to examine the empirical research that grounds the development methods and application of healthcare accreditation standards.MethodsA multi-method strategy was employed over the period March 2010 to August 2011. Five academic health research databases (Medline, Psych INFO, Embase, Social work abstracts, and CINAHL) were interrogated, the websites of 36 agencies associated with the study topic were investigated, and a snowball search was undertaken. Search criteria included accreditation research studies, in English, addressing standards and their impact. Searching in stage 1 initially selected 9386 abstracts. In stage 2, this selection was refined against the inclusion criteria; empirical studies (n = 2111) were identified and refined to a selection of 140 papers with the exclusion of clinical or biomedical and commentary pieces. These were independently reviewed by two researchers and reduced to 13 articles that met the study criteria.ResultsThe 13 articles were analysed according to four categories: overall findings; standards development; implementation issues; and impact of standards. Studies have only occurred in the acute care setting, predominately in 2003 (n = 5) and 2009 (n = 4), and in the United States (n = 8). A multidisciplinary focus (n = 9) and mixed method approach (n = 11) are common characteristics. Three interventional studies were identified, with the remaining 10 studies having research designs to investigate clinical or organisational impacts. No study directly examined standards development or other issues associated with their progression. Only one study noted implementation issues, identifying several enablers and barriers. Standards were reported to improve organisational efficiency and staff circumstances. However, the impact on clinical quality was mixed, with both improvements and a lack of measurable effects recorded.ConclusionStandards are ubiquitous within healthcare and are generally considered to be an important means by which to improve clinical practice and organisational performance. However, there is a lack of robust empirical evidence examining the development, writing, implementation and impacts of healthcare accreditation standards.

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“…The PhilHealth has been reported to increase the uptake and standards of ANC. 27 Improvements in the quality of services in healthcare institutions through accreditation and the coverage of financial costs by insurance contributed to the increased use of ANC by Filipino women regardless of the sociodemographic status. 27 28 There was also an increase in the total number of midwives and rural (barangay) health units over the years, which addressed the problems of distance and lack of availability of health workers and ANC facilities.…”

Section: Discussionmentioning

confidence: 99%

Reduction in inequality in antenatal-care use and persistence of inequality in skilled birth attendance in the Philippines from 1993 to 2008

et al. 2013

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ObjectiveTo assess changes in the inequalities associated with maternal healthcare use according to economic status in the Philippines.DesignAn analysis of four population-based data sets that were conducted between 1993 and 2008.SettingPhilippines.ParticipantsWomen aged 15–49 years who had a live-birth within 1 year in 1993 (n=1707), 1998 (n=1513), 2003 (n=1325) and 2008 (n=1209).OutcomesAt least four visits of antenatal care, skilled birth attendance and delivery in a medical facility.ResultsThe adjusted OR for antenatal-care use when comparing the highest wealth-index quintile with the lowest quintile declined from 1993 to 2008: 3.43 (95% CI 2.22 to 5.28) to 2.87 (95% CI 1.31 to 6.29). On the other hand, the adjusted OR for the other two outcome indicators by the wealth index widened from 1993 to 2008: 9.92 (95% CI 5.98 to 16.43) to 15.53 (95% CI 6.90 to 34.94) for skilled birth attendance and 7.74 (95% CI 4.22 to 14.21) to 16.00 (95% CI 7.99 to 32.02) for delivery in a medical facility. The concentration indices for maternal health utilisation in 1993 and 2008 were 0.19 and 0.09 for antenatal care; 0.26 and 0.24 for skilled birth attendance and 0.41 and 0.35 for delivery in a medical facility.ConclusionsOver a 16-year period, gradients in antenatal-care use decreased and the high level of inequalities in skilled birth attendance and delivery in a medical facility persisted. The results showed a disproportionate use of institutional care at birth among disadvantaged Filipino women.

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The population-level impacts of a national health insurance program and franchise midwife clinics on achievement of prenatal and delivery care standards in the Philippines

Cited by 30 publications

References 19 publications

What interventions are effective on reducing inequalities in maternal and child health in low- and middle-income settings? A systematic review

What interventions are effective on reducing inequalities in maternal and child health in low- and middle-income settings? A systematic review

The standard of healthcare accreditation standards: a review of empirical research underpinning their development and impact

Reduction in inequality in antenatal-care use and persistence of inequality in skilled birth attendance in the Philippines from 1993 to 2008

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