3P Study: Preliminary results of an on-going randomized experiment

1. 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

2. 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

3. 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

4. Intervention: 3P certificate • Front • Back

5. Intervention: Information packet

6. BASE-LINE Feb-Apr 2011 2,945 nationally-representative random sample of households Treatment sites (n=2242) Control sites (n=702) W/o PhilHealth – to be offered voucher and info (n= 1053) With PhilHealth (n=1187) INTER-VEN- TION Feb – Dec 2011 Not enrolled (did not use voucher) Enrolled (used voucher) FOLLOW UP Jan-Mar 2012 Survey the same 1755 households

7. 3P cohort diagram  In 230 municipalities and cities, 63 provinces, 15 regions

8. Baseline: All households, by site* *Baseline survey, unweighted samples.

9. Baseline: Eligible households, by site* *Baseline survey, unweighted samples.

10. Enrolment among 3P certificate holders* *As of 3 Oct. 2011. Unweighted samples.

11. Selected SMS replies “Bkit ngayon po lang kyo sumagot nkadaan na bangka, wla na me masasakyan.” Sender from Rizal “hindi kopa na file. ang philhealth. form kc gepit pa sd pera. sa ngaun. baka sa june na po!” Sender from Leyte “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 “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 “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

12. 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.