Impact of Incentives and Information on Quality and Utilization in Primary Care 2014
Philippine Health Insurance Corporation (PhilHealth) launched the Primary Care Benefit 1 (PCB1) package in April 1, 2012. This insurance is an enhancement of the Corporation's Outpatient Benefit (OPB) package. PCB1 aims to improve the utilization of the outpatient package as well as the quality and efficiency of health services. It shifted the payment mechanism from a capitation payment scheme tied solely on the enrollment of sponsored members to a performance based payment scheme. A critical challenge for PhilHealth in implementing the PCB 1 is the devolution of health services to the Local Govemment Units (LGUs). The role of patients is also considered as a key to activate the causal chain in quality improvement through a payment for performance (P4P) scheme.
Recognizing the opportunities and to address the challenges for more effective delivery of PCB 1 services, PhilHealth is collaborating with researchers from the World Bank and the Impact Evaluation Lab of the Korean Development Institute School for a randomized evaluation of supplementary interventions to the PCB1. This study is called Impact of Incentives and Information on Quality and Utilization in Primary Care (I3QUiP).The evaluation results will help PhilHealth improve the implementation of PCB1 for a more effective partnership in the delivery of quality health services.
Researchers are examining the impact of three measures being implemented:
- direct payments to providers with increased autonomy on the distribution of the amount,
- increased disclosure of information,
- combination of direct payments and increased disclosure of information.
The baseline survey was conducted from April to June 2014, collecting information from 240 local government units (municipalities or cities).
Kind of data
Sample survey data [ssd]
v01, edited, anonymous datasets
All personal identifiers and identifiers of specific health facilities have been removed.
Fourteen out of 17 regions in the country were included in the study. The three exluded regions were the National Capital Region (NCR), the Autonomous Region of Muslim Mindanao (ARMM) and Region VIII.
NCR and ARMM were not considered as part of the study from the early stages of the study design. ARMM does not have health services decentralized at the municipality level and therefore the interventions are not relevant. NCR was considered having too many rural health units (RHUs) and was excluded to prevent biasing the findings. Region VIII was severely affected by typhoon Haiyan/Yolanda in November 2013 prior to implementation of the baseline survey.
Unit of analysis
- Local government units
- PCB-accredited rural health units
To become PCB-accredited, the local government unit (LGU) applies for accreditation of its rural health units (RHU) to become a provider of the PhilHealth PCB1 package. When Philippine Health Insurance Corporation (PhilHealth) approves that the RHU meets the service delivery standards of a PCB1 provider based on a review of the facilities and its staff, the accreditation is formalized with the LGU applying for accreditation and signing a Performance Commitment signifying compliance to the guidelines of the PCB1 package.
Producers and sponsors
Damien B.C.M da Walque
Korean Development Institute
Philippines National Health Insurance Corporation
Former primary investigator (PI) and former task team leader (TTL)
Philippines Health Insurance Corporation
World Bank (The Strategic Impact Evaluation Fund)
Korean Development Institute
The sample of 240 local government units (LGU) was selected by PhilHealth from PCB1-engaged LGUs that are willing to participate in the study. Randomization of LGUs was conducted at the municipality level, stratified at the regional level and then at the provincial level.
Two to three provinces were randomly chosen from each of the 14 regions included in the study. This resulted in 30 provinces, with two provinces each from 12 regions and three provinces each from 2 regions.
In each of the selected provinces, eight LGUs were selected from the list of LGUs with PCB-accredited rural health units (RHU) as of June 2013 provided by PhilHealth. In total, there were 1,120 LGUs with PCB-accredited RHUs nationwide. In provinces with less than eight municipalities/cities with PCB-accredited RHUs, the remaining LGUs were randomly sampled from another province in the same region to add up to 16 LGUs per region, except for Regions VI and VII where a total of 24 LGUs were selected for each region.
During the conduct of the baseline survey, the 240 LGUs were randomly assigned into the four treatment arms, including the control arm, stratified by province. There are therefore 60 LGUs per treatment arm, evenly spread across the regions and provinces. The assignments were only notified to the LGUs and the health facilities after the baseline survey, at the time of the orientation of the study conducted between September and November, 2014. The orientations to LGUs were attended by the Local Chief Executive, the Municipal Health Officer (usually the rural health physician in the main RHU), and the Municipal Accountant. The orientations were given by treatment arm based on treatment-specific manuals, to ensure that there was no contamination.
Dates of collection
Mode of data collection
Data was collected in local government units (LGU) and rural health units (RHU) using the following survey instruments and methods:
- Interviews with key informants, including a local chief executive
- interviews with RHU physician
- RHU/health facility survey
- patient chart reviews for selected diseases
- direct observation of clinical management of patients (only in a subset of study sites)
- patient exit survey
- collection of a sample of patient health profiles.
Use of the dataset must be acknowledged using a citation which would include:
- the Identification of the Primary Investigator
- the title of the survey (including acronym and year of implementation)
- the survey reference number
- the source and date of download
Damien B.C.M da Walque, World Bank, Taejong Kim, Korean Development Institute, John Basa, Philippines National Health Insurance Corporation. Philippines Impact of Incentives and Information on Quality and Utilization in Primary Care 2014, Baseline Survey. Ref. PHL_2014_I3QUIPIE-BL_v01_M. Dataset downloaded from [url] on [date].
Disclaimer and copyrights
The user of the data acknowledges that the original collector of the data, the authorized distributor of the data, and the relevant funding agency bear no responsibility for use of the data or for interpretations or inferences based upon such uses.