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Do Health Reforms to Improve Quality Have Long‐Term Effects? Results of a Follow‐Up on a Randomized Policy Experiment in the Philippines
Author(s) -
Quimbo Stella,
Wagner Natascha,
Florentino Jhiedon,
Solon Orville,
Peabody John
Publication year - 2016
Publication title -
health economics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.55
H-Index - 109
eISSN - 1099-1050
pISSN - 1057-9230
DOI - 10.1002/hec.3129
Subject(s) - payment , intervention (counseling) , psychological intervention , randomized controlled trial , medicine , control (management) , quality (philosophy) , health insurance , demography , health care , physical therapy , family medicine , nursing , business , economics , finance , economic growth , surgery , philosophy , management , epistemology , sociology
We tracked doctors who had previously participated in a randomized policy experiment in the Philippines. The original experiment involved 30 district hospitals divided equally into one control site and two intervention sites that increased insurance payments (full insurance support for children under 5 years old) or made bonus payments to hospital staff. During the 3 years of the intervention, quality—as measured by clinical performance and value vignettes—improved and was sustained in both intervention sites compared with controls. Five years after the interventions were discontinued, we remeasured the quality of care of the doctors. We found that the intervention sites continued to have significantly higher quality compared with the control sites. The previously documented quality improvement in intervention sites appears to be sustained; moreover, it was subject to a very low (less than 1% per year) rate of decay in quality scores. Copyright © 2015 John Wiley & Sons, Ltd.