The long-term consequences of poverty on child health, including cognitive development, are one of the world's great tragedies. In the Philippines, diarrhea, acute lower respiratory infections, and the attendant problems of malnutrition, are the leading causes of childhood illness. The Philippine government plans to launch a broad national Health Sector Reform Agenda (HSRA) that will address the problems of poverty and illness in children. The introduction of these reforms provides an exceptional opportunity to conduct a social experiment. Four institutions, already involved in the design and implementation of the HSRA, plus leading experts in international health, government, and health measurement will collaborate on this project to collect longitudinal data and measure the impact of HSRA reforms on child health outcomes in a population. We will measure the health impacts of two experimental interventions: (1) expansion of health insurance coverage, and (2) capitation of providers. Our research will measure the impact of health reforms on the physical and cognitive health outcomes of children age 0-4. We will use a block design of 21 sites throughout the Philippines: seven for each of the two interventions, and seven matched controls. We will measure the quality of clinical practice using vignettes and will measure health outcomes using objective clinical tests. We will also use an advanced sampling strategy and panel data to link clinical practice with population health outcomes. This unparalleled research opportunity will yield significant insights about specific, unanswered questions of tremendous importance: Does health care serve as a social intervention that ameliorates the effects of morbidity and malnutrition on cognitive development? How effective are government policies at creating incentives to improve the quality of clinical practice? Do financial and organizational policies actually lead to better health and developmental outcomes? The results from this study will provide insights into the linkages between increased access, high quality care, and health outcomes in children.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Research Project (R01)
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Study Section
Social Sciences, Nursing, Epidemiology and Methods 4 (SNEM)
Program Officer
Spittel, Michael
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University of California San Francisco
Public Health & Prev Medicine
Schools of Medicine
San Francisco
United States
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Wagner, Natascha; Quimbo, Stella; Shimkhada, Riti et al. (2018) Does health insurance coverage or improved quality protect better against out-of-pocket payments? Experimental evidence from the Philippines. Soc Sci Med 204:51-58
Peabody, John W; Shimkhada, Riti; Quimbo, Stella et al. (2014) The impact of performance incentives on child health outcomes: results from a cluster randomized controlled trial in the Philippines. Health Policy Plan 29:615-21
Butrick, Elizabeth; Peabody, John W; Solon, Orville et al. (2012) A comparison of objective biomarkers with a subjective health status measure among children in the Philippines. Asia Pac J Public Health 24:565-76
Quimbo, Stella A; Peabody, John W; Shimkhada, Riti et al. (2011) Evidence of a causal link between health outcomes, insurance coverage, and a policy to expand access: experimental data from children in the Philippines. Health Econ 20:620-30
Peabody, John; Shimkhada, Riti; Quimbo, Stella et al. (2011) Financial incentives and measurement improved physicians' quality of care in the Philippines. Health Aff (Millwood) 30:773-81
Quimbo, Stella; Peabody, John W; Javier, Xylee et al. (2011) Pushing on a String: How policy might encourage private doctors to compete with the public sector on the basis of quality. Econ Lett 110:101-103
Panelo, Carlo Irwin A; Shimkhada, Riti; Solon, Orville C et al. (2011) Understanding predictors of postdischarge deaths: a prospective evaluation of children 5 years and younger discharged from Philippine district hospitals. Asia Pac J Public Health 23:133-40
Peabody, John W; Florentino, Jhiedon; Shimkhada, Riti et al. (2010) Quality variation and its impact on costs and satisfaction: evidence from the QIDS study. Med Care 48:25-30
Solon, Orville; Woo, Kimberly; Quimbo, Stella A et al. (2009) A novel method for measuring health care system performance: experience from QIDS in the Philippines. Health Policy Plan 24:167-74
Kraft, Aleli D; Quimbo, Stella A; Solon, Orville et al. (2009) The health and cost impact of care delay and the experimental impact of insurance on reducing delays. J Pediatr 155:281-5.e1

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