Evidence map›Paper›PMID 28110265›Full record

Trial reportHealth policy and planning2017

Comparative effectiveness of two disparate policies on child health: experimental evidence from the Philippines.

John W Peabody, Stella Quimbo, Jhiedon Florentino, Riti Shimkhada, Xylee Javier, David Paculdo, Dean Jamison, Orville Solon

Abstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Health policy and planning, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
10citing papers in PubMed, 3 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

10 citing papers in PubMed, 3 syntheses or guidelines pooled it.

  1. Pooled it
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

John W PeabodyGlobal Health Sciences, University of California, San Francisco, CA, USA.
Stella QuimboUniversity of the Philippines, School of Economics, Phillippines.
Jhiedon FlorentinoQURE Healthcare, San Francisco, CA, USA.
Riti ShimkhadaCenter for Health Policy Research, University of California, Los Angeles, CA, USA.
Xylee JavierUniversity of the Philippines, School of Economics, Phillippines.
David PaculdoQURE Healthcare, San Francisco, CA, USA.
Dean JamisonDepartment of Global Health, University of Washington, WA, USA.
Orville SolonUniversity of the Philippines, School of Economics, Phillippines.

Funding

The Philippine Child Health and Policy ExperimentR01HD042117 · NICHD · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI PEABODY, JOHN W · 2003 to 2007
$2.5M
NICHD NIH HHS R01 HD042117
6 · The paper itself

Abstract

backgroundShould 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.

methodsThe 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.

resultsThe 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.

conclusionP4P 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.

Indexed as

Child HealthCost-Benefit AnalysisChild, PreschoolHealth ServicesHumansInfantInfant, NewbornInsurance CoveragePhilippinesQuality ImprovementReimbursement, IncentiveUniversal Health InsuranceComparative effectivenesspay for performancePhilippinespolicy experimentuniversal health coverage

Identifiers

PMID28110265
PMCPMC5400045

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.