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Does coupling of 4Ps and PhilHealth Sponsored Program
induce those with TB symptoms to seek treatment?
Mel Lorenzo M. Accad Graduate Student
PROGRAM OVERVIEW: Pantawid Pamilyang Pilipino Program (4Ps)
– Cash transfer to the poor
– Started in 2008 and still running
– Administered by Department of Social Welfare and Development (DSWD)
– Funded by taxes and development assistance
ELIGIBILITY: 4Ps
Those located in selected municipalities and barangays (based on Proxy Means Test, also known as National Household Targeting System for Poverty Reduction (NHTS-PR))
Household (per capita) income below provincial poverty line
With children aged 0-14 years old (6-14 years old must be in school) or have pregnant woman at the time of registration into the program
Commitment to follow the conditions
Those who passed the Eligibility Check Routine 2, which delineates those with regular income and subjects them to further validation.
BENEFITS & CONDITIONS: 4Ps
Health Grant: PhP 500 (around US$ 11.50) per household per month
Conditions:
(i) Children under five years old should visit the health center or rural health unit regularly;
(ii) Pregnant women attend the health center or rural health unit according to DOH protocol
(iii) All school-aged children (6-14 years old) comply with the de-worming protocol at schools
(iv) For households with children 0-14 years old, the mother or father should attend Family Development Sessions at least once a month.
BENEFITS & CONDITIONS: 4Ps
Education Grant: PhP 300 (about US$ 6.89) per child per month (for a period of 10 months/year), for up to a maximum of three children
Condition: School-aged children (6-14 years old) enrolled in primary or secondary school and attend 85% of the school days every month
DELIVERY SYSTEM: 4Ps
Compliance is monitored using Compliance Verification System (CVS) bimonthly CVS forms are distributed to schools and health facilities School teachers and health facility workers verify
compliance
As of July 2011, from the impact evaluation survey done by DSWD: 43% received grants through ATM cash cards 30% though Globe G-Remit merchants 18% through Rural Bank 9% through over-the-counter at Land Bank branches.
PROGRAM OVERVIEW: PhilHealth Sponsored Program (SP)
– Health insurance targeted for the poor
– Started in 1996 and still running
– Administered by National Health Insurance Corporation (a.k.a. PhilHealth)
– Funded by Local Government Units (LGUs) and National Government (NG) and sometimes by nongovernment organizations
ELIGIBILITY: PhilHealth Sponsored Program (SP)
Original 1996 Rules:
Means test is administered by the Social Welfare Development officer at the Local Government Unit level
Target beneficiaries are the lowest 25 percent of the local population
Identified through the Community Based Information System-Minimum Basic Needs Indicators and a uniform family threshold, which is then verified by the PhilHealth family data survey.
The list is submitted to the LGU for verification and decision making
(Suffers from inclusion and exclusion errors due to loopholes in means test. (Chakraborty, 2013))
ELIGIBILITY: PhilHealth Sponsored Program (SP)
Beginning 2009:
National Government would pay only for NHTS-PR identified households.
BENEFITS: PhilHealth SP
TYPE OF BENEFIT
DETAILS OF COVERAGE ONLY FOR POOR
OR ALL NHIP?
Inpatient Acute Care
First-peso coverage for hospitalization. Payment is on a fee-for-service basis, up to a limit identified by PhilHealth. PhilHealth pays for (a) room and board (b) services of health care professionals (c) diagnostic, laboratory, and other medical
examination services; (d) use of surgical or medical equipment and
facilities; (e) prescription drugs, subject to limitations; (f) inpatient education packages. Hospitals are
allowed to balance bill over and above the PhilHealth payments. Prices are not regulated by PhilHealth and are not transparent.
For all members
Table from (Chakraborty, 2013)
BENEFITS: PhilHealth SP
TYPE OF BENEFIT
DETAILS OF COVERAGE ONLY FOR POOR
OR ALL NHIP?
Inpatient Acute Care
No Balance Billing package where public hospitals are paid a fixed rate per case. Initially, 23 cases are included PhilHealth hopes to cover all cases in 2012.
Only for Sponsored Program using services in public hospitals. For private hospitals, case rates apply but private
Table from (Chakraborty, 2013)
BENEFITS: PhilHealth SP
TYPE OF BENEFIT DETAILS OF COVERAGE ONLY FOR
POOR OR ALL NHIP?
Special packages TB DOTS (Tuberculosis Directly Observed Therapy, Short-course), Maternal and Neonatal Care
Provides fixed rates with no balance billing. Now, largely integrated into No Balance Billing scheme.
All members
Table from (Chakraborty, 2013)
BENEFITS: PhilHealth SP
TYPE OF BENEFIT
DETAILS OF COVERAGE ONLY FOR
POOR OR ALL NHIP?
Outpatient benefits
The outpatient benefits cover primary consultation with general physicians, as well as lab tests such as complete X-rays, fecal and urine analysis, complete blood count, and sputum microscopy.
Only SP
Table copied from (Chakraborty, 2013)
DATA
Family Health Survey 2011
- Done by National Statistics Office
- HH respondents: 49,374 (226,392 HH members)
- Survey round: August 2011
DATA STRUCTURE
All Household Members
N=226,392
No TB Symptoms
n=223,072
With TB Symptoms
n=3,320
Did not seek treatment (Y=0)
n=887
Why?
Sought treatment (Y=1)
n=2,433
Where did (hh member) seek
treatment?
Survey question: Has any member of your household ever had symptoms of tuberculosis like coughing for two weeks or longer, recurring fever for two weeks or longer, or coughing up of blood?
OUTCOME VARIABLE
873
436
254
77 224
31
3
Non SP-PH Insurance
n=984
4Ps n=558
SP-PH n=694
With TB Symptoms (n=3,320)
No insurance & no 4Ps n=1422
0.00
0.10
0.20
0.30
0.40
0.50
0.60
0.70
0.80
0.90
1.00
0.00 0.20 0.40 0.60 0.80 1.00
Cum
ula
tive
% o
f outc
om
e var
iable
Cumulative % of population, ranked from poorest to richest
Line of equality Did not seek treatment for TB
HH Member with TB sought treatment HH Member has TB Symptom
TB ACROSS WEALTH QUINTILES
Tuberculosis is concentrated among the poor Tuberculosis treatment is concentrated among the rich
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
Did not seek treatment for TB
HH Member with TB sought in a health care facility
AMONG WITH TB SYMPTOMS
WHERE DO THEY SEEK TREATMENT? (non-exclusive responses)
The poor’s first choice of facility is the Public Health Center
0%
10%
20%
30%
40%
50%
60%
Lowestquintile
2 3 4 Highestquintile
Total
Public Health Center Public Hospital Private Hospital or Clinic
WHY MANY DON’T SEEK TREATMENT? (non-exclusive responses)
Many would resort to self-medication.
0.00%2.00%4.00%6.00%8.00%
10.00%12.00%14.00%16.00%18.00%20.00%
1 2 3 4 5 Total
Self-Medication Cost DistanceSymptoms Harmless Embarassed Others
WEALTH QUINTILE
METHODOLOGY
Propensity Score Matching
- Observation data (non-randomized/quasi-experimental)
- Solves curse of dimensionality
Ignorability Assumption for ATT: Weaker Unconfoundedness: 𝑌0 ⊥ 𝑇|𝑃(𝒙) Overlap: 0 < 𝑃 𝑇 = 1 𝒙 < 1
PSM Estimator:
𝜏𝐴𝑇𝑇𝑃𝑆𝑀 = 𝐸𝑃 𝑋 |𝑇=1{𝐸 𝑌 1 𝑇 = 1, 𝑃 𝑋 − 𝐸 𝑌 0 𝑇 = 0, 𝑃 𝑋 }
BALANCING TEST
Variables in PSM
Nearest Neighbor N=1, common, ties
Nearest Neighbor N=2, cal(0.01), common, ties
Mean (4Ps=1)
Mean (4Ps=0)
SB (%) p>t Mean
(4Ps=1) Mean
(4Ps=0) SB (%) p>t
1 Female HH Member 43.518 33.466 42.1 0 43.179 34.135 37.9 0
2 Number of HH Members 0.43244 0.3722 12.3 0.081 0.41288 0.36486 9.8 0.163
3 Number of HH Members aged 0 to 1 5.1714 6.6233 -59.1 0 5.3076 6.5586 -51 0
4 Number of HH Members aged 02 to 17 0.13168 0.30045 -34.3 0 0.13145 0.29054 -32.3 0
5 HH Head 2.1889 3.4081 -68.2 0 2.1819 3.3604 -65.9 0
6 Age of HH Head 0.51985 0.35874 33.7 0 0.50172 0.37387 26.7 0
7 Male Head of Household 49.998 45.874 30.7 0 50.116 45.712 32.7 0
8 HGC of HH Head: some elementary 0.89504 0.95067 -18.6 0.008 0.90772 0.92793 -6.8 0.314
9 HGC of HH Head: elementary graduate 0.25725 0.43946 -38.4 0 0.27321 0.42117 -31.2 0
10 HGC of HH Head: some high school 0.14198 0.12556 -56511 0.498 0.14215 0.15541 -45601 0.588
11 HGC of HH Head: high school graduate 0.17595 0.18834 -3.8 0.642 0.18647 0.16667 6.1 0.466
12 HGC of HH Head: some college 0.18168 0.11211 20.2 0.009 0.17788 0.12613 15 0.051
13 HGC of HH Head: college graduate 0.02328 0.02242 0.4 0.935 0.06649 0.02027 20.8 0.006
14 Rural 0.09847 0.03139 33.3 0.001 0.05369 0.02027 16.6 0.03
15 II - Cagayan Valley 0.6855 0.81166 -28.7 0 0.67386 0.81081 -31.1 0
16 III - Central Luzon 0.02328 0.03139 -4.6 0.447 0.02331 0.03604 -7.2 0.237
BALANCING TEST
Variables in PSM
Nearest Neighbor N=1, common, ties
Nearest Neighbor N=2, cal(0.01), common, ties
Mean (4Ps=1)
Mean (4Ps=0)
SB (%) p>t Mean
(4Ps=1) Mean
(4Ps=0) SB (%) p>t
17 V - Bicol 0.01069 0 7.5 0.121 0.01509 0 10.6 0.065
18 VI - Western Visayas 0.03092 0.12108 -33.5 0 0.03515 0.12162 -32.1 0
19 VII - Central Visayas 0.06412 0.08969 -9.9 0.14 0.05923 0.07883 -7.6 0.241
20 VIII - Eastern Visayas 0.05305 0.04484 4.3 0.598 0.06057 0.03829 11.7 0.176
21 IX - Zamboanga Peninsula 0.04084 0.0852 -19.1 0.002 0.04547 0.08108 -15.3 0.017
22 X - Northern Mindanao 0.03893 0.08969 -21.2 0 0.04968 0.08784 -16 0.015
23 XI - Davao 0.06298 0.10762 -16.7 0.01 0.04987 0.12613 -28.6 0
24 XII - SOCCSKSARGEN 0.03664 0.01794 11.2 0.146 0.0277 0.00901 11.2 0.094
25 NCR 0.0542 0.06726 -5.5 0.412 0.06362 0.06306 0.2 0.974
26 CAR 0.1874 0.03587 52.8 0 0.18284 0.04279 48.8 0
27 ARMM 0.0187 0.00897 5.1 0.293 0.02159 0.01577 3.1 0.563
28 XIII - CARAGA 0.16145 0.11211 15.5 0.052 0.19201 0.10811 26.3 0.002
29 IVA - CALABARZON 0.02137 0.02691 -2.8 0.587 0.02102 0.03378 -6.5 0.213
30 IVB - MIMAROPA 0.01031 0.00448 2.6 0.398 0.01165 0.01351 -0.8 0.806
31 Wealth asset index: 2 0.07061 0.1435 -24.1 0 0.06171 0.13288 -23.5 0
32 Wealth asset index: 3 0.16908 0.24215 -18.7 0.006 0.14043 0.23874 -25.1 0
33 Wealth asset index: 4 0.1145 0.13901 -6.9 0.273 0.16603 0.1509 4.2 0.56
34 Wealth asset index: 5 0.05229 0.09865 -16.1 0.004 0.06649 0.08333 -5.9 0.338
35 Wealth asset index: 6 0.14504 0.0852 18.5 0.014 0.1219 0.12613 -1.3 0.853
36 Wealth asset index: 7 0.0458 0.08072 -12.9 0.02 0.05216 0.07207 -7.3 0.207
37 Wealth asset index: 8 0.14198 0.0583 33.5 0 0.15075 0.0473 41.4 0
38 Wealth asset index: 9 0.09504 0 47.1 0 0.05044 0.00225 23.9 0.001
39 Wealth asset index: 10 0 0 . . 0 0 . .
BALANCING TEST
Variables in PSM
Radius cal(0.001), common, ties
Kernel biweight, bw=0.01, common
Mean (4Ps=1)
Mean (4Ps=0)
SB (%) p>t Mean
(4Ps=1) Mean
(4Ps=0) SB (%) p>t
1 Female HH Member 40.8 32.573 34.5 0 42.366 33.287 38 0
2 Number of HH Members 0.39517 0.422 -5.5 0.461 0.38087 0.4069 -5.3 0.444
3 Number of HH Members aged 0 to 1 5.3196 6.1741 -34.8 0 5.4466 6.5262 -44 0
4 Number of HH Members aged 02 to 17 0.17097 0.26221 -18.5 0.003 0.16326 0.28551 -24.8 0
5 HH Head 2.3219 3.0552 -41 0 2.2779 3.3604 -60.6 0
6 Age of HH Head 0.51022 0.33175 37.3 0 0.50978 0.34405 34.6 0
7 Male Head of Household 49.015 45.646 25.1 0.001 49.682 45.893 28.2 0
8 HGC of HH Head: some elementary 0.89614 0.92442 -9.5 0.206 0.91346 0.92263 -3.1 0.64
9 HGC of HH Head: elementary graduate 0.27074 0.43063 -33.7 0 0.24582 0.44997 -43.1 0
10 HGC of HH Head: some high school 0.16368 0.17328 -32979 0.728 0.17287 0.17666 -12957 0.886
11 HGC of HH Head: high school graduate 0.15046 0.14782 0.8 0.921 0.15798 0.14473 4.1 0.602
12 HGC of HH Head: some college 0.20658 0.11397 26.9 0.002 0.17536 0.10774 19.6 0.01
13 HGC of HH Head: college graduate 0.04342 0.0216 9.8 0.139 0.08247 0.0171 29.4 0
14 Rural 0.04955 0.02608 11.6 0.136 0.06375 0.0217 20.8 0.012
15 II - Cagayan Valley 0.6982 0.8265 -29.2 0 0.66328 0.8382 -39.8 0
16 III - Central Luzon 0.02989 0.02911 0.4 0.95 0.02272 0.02668 -2.2 0.706
BALANCING TEST
Variables in PSM
Radius cal(0.001), common, ties
Kernel biweight, bw=0.01, common
Mean (4Ps=1)
Mean (4Ps=0)
SB (%) p>t Mean
(4Ps=1) Mean
(4Ps=0) SB (%) p>t
17 V - Bicol 0.01582 0.00362 8.5 0.17 0.01412 0.00411 7 0.212
18 VI - Western Visayas 0.03585 0.08662 -18.8 0.001 0.04175 0.10885 -24.9 0
19 VII - Central Visayas 0.06279 0.09 -10.6 0.139 0.04846 0.07821 -11.6 0.053
20 VIII - Eastern Visayas 0.05193 0.0345 9.2 0.282 0.04807 0.03733 5.7 0.469
21 IX - Zamboanga Peninsula 0.04322 0.08506 -18 0.008 0.04887 0.08516 -15.6 0.019
22 X - Northern Mindanao 0.06235 0.09069 -11.9 0.123 0.04972 0.08107 -13.1 0.044
23 XI - Davao 0.06801 0.10444 -13.7 0.058 0.05012 0.10945 -22.2 0
24 XII - SOCCSKSARGEN 0.03219 0.01295 11.6 0.13 0.03042 0.01187 11.1 0.114
25 NCR 0.06651 0.05743 3.8 0.621 0.10331 0.06559 15.8 0.073
26 CAR 0.13897 0.03706 35.5 0 0.14969 0.03298 40.6 0
27 ARMM 0.02377 0.02283 0.5 0.933 0.01852 0.03054 -6.3 0.214
28 XIII - CARAGA 0.17204 0.13049 13 0.134 0.19047 0.12812 19.6 0.022
29 IVA - CALABARZON 0.02891 0.03672 -4 0.536 0.02689 0.03721 -5.3 0.369
30 IVB - MIMAROPA 0.02009 0.01688 1.4 0.756 0.02256 0.01582 3 0.512
31 Wealth asset index: 2 0.06834 0.14068 -23.9 0 0.05077 0.12825 -25.6 0
32 Wealth asset index: 3 0.16141 0.24306 -20.9 0.003 0.14201 0.23116 -22.8 0
33 Wealth asset index: 4 0.15538 0.15759 -0.6 0.935 0.16137 0.16453 -0.9 0.902
34 Wealth asset index: 5 0.07405 0.0908 -5.8 0.394 0.07443 0.10238 -9.7 0.133
35 Wealth asset index: 6 0.13026 0.12766 0.8 0.917 0.10715 0.10908 -0.6 0.929
36 Wealth asset index: 7 0.05713 0.06843 -4.2 0.517 0.09168 0.07403 6.5 0.378
37 Wealth asset index: 8 0.09135 0.04843 17.2 0.04 0.12107 0.04554 30.3 0.001
38 Wealth asset index: 9 0.04422 0.00343 20.2 0.005 0.05627 0.00337 26.2 0.001
39 Wealth asset index: 10 0 0 . . 0 0 . .
BALANCING TEST
Sample Pseudo R2 LR chi2 p>chi2 Mean Bias
Med Bias
(NN1 ties) Raw 0.192 312.69 0 21.3 20
Matched 0.19 287.76 0 21.2 18.5
(NN2 caliper .01) Raw 0.192 312.69 0 21.3 20
Matched 0.18 279.81 0 19.4 15.3
(Radius caliper .001) Raw 0.192 312.69 0 21.3 20
Matched 0.149 192.64 0 15.1 11.9
(Kernel biweight bw .01) Raw 0.192 312.69 0 21.3 20
Matched 0.164 255.8 0 18.7 15.8
BALANCING TEST
-100 -50 0 50 100Standardized % bias across covariates
Unmatched
Matched
NN1 ties
BALANCING TEST
-100 -50 0 50 100Standardized % bias across covariates
Unmatched
Matched
NN2 caliper .01
BALANCING TEST
-50 0 50 100Standardized % bias across covariates
Unmatched
Matched
Radius caliper .001
BALANCING TEST
-50 0 50 100Standardized % bias across covariates
Unmatched
Matched
Kernel biweight bw .01
PSM Model VARIABLE Odds Ratio SE P-value
Age of HH Member 0.0015104 0.004818 0.754
Female HH Member -0.0210438 0.17863 0.906
Number of HH Members 0.0400057 0.061233 0.514
Number of HH Members aged 0 to 1 0.1733811 0.178011 0.33
Number of HH Members aged 02 to 17 0.2951637 0.077344 0
HH Head -0.2545795 0.222817 0.253
Age of HH Head -0.0177732 0.007463 0.017
Male Head of Household -0.0130309 0.284457 0.963
Highest Grade Completed of HH Head
No Grade Completed (BASE)
some elementary 0.371862 0.294319 0.206
elementary graduate -0.1514243 0.330928 0.647
some high school -0.1947114 0.358036 0.587
high school graduate -0.4117733 0.376241 0.274
some college -1.223636 0.595218 0.04
college graduate -0.1621539 0.589137 0.783
Rural 0.73974 0.218979 0.001
Region
I - Ilocos (BASE)
II - Cagayan Valley -0.0267645 0.678676 0.969
III - Central Luzon -1.251356 1.147592 0.276
V - Bicol 1.040549 0.571664 0.069
Observations 3112
LR Chi2 309.08
Prob > chi2 0
Psuedo R2 0.1901
Log likelihood -658.27552
VI - Western Visayas 0.6837197 0.585911 0.243
VII - Central Visayas -0.0937214 0.660308 0.887
VIII - Eastern Visayas 0.6417174 0.595797 0.281
IX - Zamboanga Peninsula 0.8615423 0.592642 0.146
X - Northern Mindanao 1.113782 0.57985 0.055
XI - Davao -0.7059965 0.791642 0.372
XII - SOCCSKSARGEN 0.3140553 0.602941 0.602
NCR -0.2408728 0.659442 0.715
CAR 0.1318876 0.654468 0.84
ARMM -0.2585838 0.574716 0.653
XIII - CARAGA 1.012777 0.624084 0.105
IVA - CALABARZON -0.8274877 0.735275 0.26
IVB - MIMAROPA 0.8991848 0.5679 0.113
Wealth-asset decile
1 (BASE)
2 0.2898254 0.214544 0.177
3 0.2141455 0.240349 0.373
4 0.1872435 0.292533 0.522
5 0.2503782 0.272232 0.358
6 -0.3721308 0.342124 0.277
7 -0.1649599 0.383582 0.667
8 -2.312744 1.035179 0.025
9 0 (empty)
10 -1.18896 1.088415 0.275
Constant -3.541959 0.822363 0
PSM Model
Average Treatment Effects on the Treated
Coupled SP PhilHealth and 4Ps
ATT Bootstrap Std. Err.
z P>z [95% Conf. Interval]
(NN1 ties) 0.0807175 0.056962 1.42 0.156 -0.030926 0.192361
(NN2 caliper .01) 0.045045 0.0570076 0.79 0.429 -0.0666878 0.1567779
(Radius caliper .001) 0.073419 0.0403816 1.82 0.069 -0.0057274 0.1525655
(Kernel biweight bw .01) 0.0674947 0.0380736 1.77 0.076 -0.0071281 0.1421175
We cannot use PSM because of imbalance
ALTERNATIVE METHODOLOGY
Inverse Probability Weighted Regression Adjustment (IPWRA)
- Also known as “Wooldridge’s double-robust estimators”
- Uses observation data (non-randomized/quasi-experimental)
ALTERNATIVE METHODOLOGY
Inverse Probability Weighted Regression Adjustment (IPWRA)
- Allows multivalued treatments - Has potential efficiency gains in estimation compared
to binary treatment effect models. (Cattaneo, 2010)
- Double robustness feature - Either the outcome model or treatment model should
be correctly specified. (Brookhart, 2006) - Offers protection against mismodelling
- Available in Stata® 13 (teffects ipwra)
ALTERNATIVE METHODOLOGY
Inverse weighting intuition:
𝐸𝑍𝑌1
Pr(𝑍 = 1|𝑿)= 𝐸 𝐸
𝑍𝑌1Pr(𝑍 = 1|𝑿)
|𝑌1, 𝑿
= 𝐸𝑌1
Pr(𝑍 = 1|𝑿)𝐸 𝑍|𝑌1, 𝑿 = 𝐸
𝑌1Pr(𝑍 = 1|𝑿)
𝐸 𝑍|𝑿
= 𝐸𝑌1
Pr(𝑍 = 1|𝑿)Pr(𝑍 = 1|𝑿) = 𝐸 𝑌1
Same idea for
𝐸(1 − 𝑍)𝑌
1 − Pr(𝑍 = 1|𝑿)= 𝐸(𝑌0)
ALTERNATIVE METHODOLOGY
Inverse weighting intuition:
-Imitating conditional independence
ALTERNATIVE METHODOLOGY
Adjustment intuition (double robustness):
𝜇1,𝐷𝑅 = 𝐸𝑍𝑌
Pr(𝑍 = 1|𝑿)−
𝑍 − Pr 𝑍 = 1 𝑿
Pr(𝑍 = 1|𝑿)𝑚1 𝑿,𝜶1
= 𝐸 𝑌1 + 𝐸𝑍 − Pr 𝑍 = 1 𝑿
Pr(𝑍 = 1|𝑿)𝑌1 −𝑚1 𝑿,𝜶1
Where 𝑚1 𝑿,𝜶1 is the regression 𝐸(𝑌|𝑍 = 1, 𝑿)
(Bang, 2005)
ALTERNATIVE METHODOLOGY
Inverse Probability Weighted Regression Adjustment (IPWRA):
-Combination of regression adjustment and inverse weighting
- Double robustness feature - Either the outcome model or treatment model should
be correctly specified. (Brookhart, 2006) - Offers protection against mismodelling
ALTERNATIVE METHODOLOGY
3 steps to estimate treatment effects:
• “Estimate the treatment model to get the inverse-probability weights (aka Generalized Propensity Scores)
• Estimate the weighted regression models of outcome (using the previously estimated GPS) for each treatment level.
• Compute the means of treatment-specific potential outcomes. The contrasts of the means of treated subjects provide the ATTs.” (Stata, 2013)
TREATMENT MODEL (MULTINOMIAL LOGIT)
Treatment Model (T=0)
Treatment Model (T=1)
Treatment Model (T=2)
Treatment Model (T=3)
Treatment Model (T=4)
Number of children aged 2 to 17 living in HH
-0.012489 (0.047855)
0.1838172*** (0.0516904)
0.3044296*** (0.0658761)
0.292223*** (0.09654)
0.3778432*** (0.0701369)
HH Head's Age 0.0091881** (0.0036771)
0.0111403*** (0.0040898)
-0.0007894 (0.0060695)
-0.0046528 (0.0104303)
-0.0125862** (0.0060625)
Male Head of Household 0.616897*** (0.150317)
0.6098425*** (0.1843992)
0.4618084* (0.2678443)
0.7386561 (0.4791027)
0.2984181 (0.2824919)
HH Head's Highest Grade Completed
No grade completed (BASE)
at least some elementary 0.6842175** (0.3279966)
0.3376265 (0.2279713)
-0.5872239*** (0.2228497)
-0.213521 (0.4610485)
0.3606929 (0.2927288)
at least some high school 1.407035***
(0.3342) 0.4778156*
(0.25056) -0.366451
(0.2653387) 0.0671689
(0.5197611) 0.0770937
(0.3314792)
at least some college 1.505852*** (0.3535502)
0.2581254 (0.3163145)
-0.9523691** (0.4484758)
-0.7003886 (0.7257197)
-0.9774304 (0.6219924)
college graduate 2.184502*** (0.3703521)
0.2201995 (0.4207218)
-0.7406798 (0.6894242)
0.3301044 (0.6959221)
0.5091834 (0.5793221)
Number of Household Members
-0.1114026*** (0.0322794)
-0.0931156*** (0.0351521)
0.054403 (0.0459974)
-0.0011161 (0.0678519)
0.0210511 (0.0534132)
(CONTINUATION)
Treatment Model
(T=0) Treatment Model
(T=1) Treatment Model
(T=2) Treatment Model
(T=3) Treatment Model
(T=4)
Wealth Index
1 (BASE)
2 0.7442759*** (0.1640282)
0.1959019 (0.1460216)
-0.0712745 (0.1793485)
-0.2040703 (0.3466407)
-0.0127866 (0.1911281)
3 1.117592*** (0.1595397)
0.2087959 (0.1512296)
-0.7827049*** (0.2296348)
0.0508582 (0.3545736)
-0.1433208 (0.2136563)
4 1.520714*** (0.1658739)
0.1718862 (0.181409)
-1.304789*** (0.3340113)
0.3418545 (0.3854693)
-1.121936*** (0.3600767)
5 1.889767*** (0.1960036)
-0.396145 (0.3210582)
-2.824213*** (1.068307)
0.1695125 (0.5605466)
-1.738435** (0.7870722)
Rural -0.3436139***
(0.1018561) 0.6616151***
(0.123753) 0.8522036*** (0.1808688)
0.1440584 (0.241365)
1.195756*** (0.1953974)
Constant -2.934321*** (0.4300598)
-2.961293*** (0.3950455)
-2.935156*** (0.5358131)
-4.040772*** (0.8590472)
-3.463316*** (0.6067832)
OUTCOME MODEL (LOGIT)
Outcome Model
(T=0) Outcome Model
(T=1) Outcome Model
(T=2) Outcome Model
(T=3) Outcome Model
(T=4) Outcome Model
(T=5)
Age 0.0192353*** (0.0071983)
0.0247301 (0.0203436)
0.0136066 (0.0109159)
0.0201107** (0.010043)
0.0514428 (0.0339421)
0.0135043 (0.0134297)
Female -0.0648056 (0.2481515)
-0.2955831 (0.6110685)
-0.0309395 (0.3991441)
0.0239585 (0.4032797)
5.512328*** (2.013524)
-0.0801108 (0.3897616)
Highest Grade Completed of HH Member
Not yet school age (BASE)
No grade completed -0.4773613 (0.560275)
0.0446051 (1.541784)
-0.131107 (0.9640467)
-1.138272 (0.7871484)
1.105168 (2.021812)
-1.170832 (0.9994926)
At least some elementary -0.1269738 (0.3888676)
-1.628605 (1.065309)
0.3392404 (0.6004436)
-1.325904** (0.5492978)
-0.3465372 (2.718918)
-0.0568484 (0.5012806)
At least some high school -0.2056754 (0.4282061)
-1.097272 (1.079913)
-0.6109118 (0.6465161)
-1.181632* (0.6539884)
1.378843 (3.859887)
-0.0306106 (0.6018776)
At least some college -0.5951501 (0.6971721)
0.2476261 (1.257129)
0.7989235 (1.206587)
-0.5942801 (1.836507)
-0.8141898 (2.592809)
-18.77459*** (1.481858)
College graduate -0.9807096 (0.8999754)
-2.013056 (1.268801)
-1.810974 (1.844401)
-1.423002 (1.863799)
1.458275 (3.430481)
5.252616*** (1.253486)
Head of the Household -0.3788761 (0.3095795)
-0.9948049 (0.7707503)
-0.0380339 (0.5013057)
-0.4897258 (0.4537511)
-0.1056166 (2.441602)
0.3961802 (0.5803989)
HH Head's Age -0.0049965 (0.0093221)
0.0049575 (0.0299257)
0.0079638 (0.0163582)
-0.0026664 (0.0142646)
0.0857218 (0.0941047)
0.0040508 (0.0194835)
Male Head of Household 0.1808545 (0.2839463)
-0.0659903 (0.686284)
0.6749348 (0.4813386)
-0.8583068 (0.6757677)
4.090644 (3.246541)
0.8299323 (0.5660229)
Outcome Model
(T=0) Outcome Model
(T=1) Outcome Model
(T=2) Outcome Model
(T=3) Outcome Model
(T=4) Outcome Model
(T=5)
HH Head's Highest Grade Completed
No grade completed (BASE) (BASE) (BASE) (BASE) (BASE) (BASE) (BASE)
At least some elementary -0.1060688 (0.4462312)
2.123962 (1.691245)
-0.2441283 (0.6431428)
0.259715 (0.5739496)
2.205355 (4.00942)
-1.107434 (1.002119)
At least some high school -0.0724399 (0.4769381)
1.344151 (1.701901)
0.9172019 (0.7742388)
0.3598357 (0.6082596)
1.000282 (5.486754)
-0.1915232 (1.019125)
At least some college 0.2765999 (0.8996348)
2.128769 (1.977162)
0.480573 (0.9936923)
0.400014 (1.331291)
3.041897 (1.914576)
5.293221*** (1.266897)
College graduate 1.387625** (0.6848532)
1.753046 (1.785631)
0.3105161 (1.638518)
-0.724328 (1.687012)
6.525433 (5.102996)
-2.294781* (1.383192)
Number of Household Members
0.0480507 (0.0390328)
0.0949761 (0.1147484)
-0.0230386 (0.0707381)
0.0200825 (0.0640782)
-0.2782699 (0.5105001)
0.0605397 (0.0764978)
Wealth Index
1 (BASE) (BASE) (BASE) (BASE) (BASE) (BASE) (BASE)
2 0.6091919** (0.2809825)
1.081429* (0.5843136)
-0.5328735 (0.3811472)
0.452077 (0.3574231)
5.617542 (6.851733)
-0.3125396 (0.3819857)
3 0.8418145*** (0.2698421)
0.8392642 (0.5526513)
0.2649891 (0.4652471)
-0.0853981 (0.4671406)
0.5010141 (1.284563)
0.1151205 (0.4933197)
4 0.6538538** (0.3200278)
0.6508139 (0.7638519)
-0.0000742 (0.5182148)
3.166639* (1.879283)
-3.510464** (1.756466)
-1.224161 (0.9246503)
5 0.1877545 (0.5067382)
0.8097338 (0.7849491)
1.86209 (1.406387)
6.163549*** (1.028592)
-0.2010186 (1.942437)
5.381495*** (1.267593)
Rural -0.5637146*** (0.1935034)
-0.9628246* (0.5266025)
-0.2837467 (0.3778574)
-1.012326** (0.4349515)
-2.639913 (1.780055)
-1.307626** (0.5105286)
Constant 0.3166354 (0.7520693)
-0.4150566 (2.398635)
-0.1762123 (1.397285)
2.028701 (1.281933)
-7.742066 (8.335906)
1.148707 (1.554198)
(CONTINUATION)
AVE. TREATMENT EFFECTS ON THE TREATED SET AS CONTROL GROUP
w/o 4Ps
w/o Any
Insurance
T=0
w/o 4Ps
w/ insurance - NOT
SP PhilHealth
T=1
w/o 4Ps
w/ insurance -SP
PhilHealth
T=2
w/ 4Ps
w/o insurance
T=3
w/ 4Ps
w/ insurance -
NOTSP PhilHealth
T=4
w/o 4Ps
w/o Any Insurance
-0.045323 (0.0680229)
-0.0318995 (0.0384487)
0.0993387** (0.0402397)
-0.0805385 (0.0966056)
w/o 4Ps
w/ insurance - NOT SP
PhilHealth
0.045323 (0.0680229)
0.0134235
(0.0725404) 0.1446617** (0.0722104)
-0.0352155 (0.1150766)
w/o 4Ps
w/ insurance -SP PhilHealth
0.0318995 (0.0384487)
-0.0134235 (0.0725404)
0.1312382*** (0.0470622)
-0.048639 (0.1001861)
w/ 4Ps
w/o insurance
-0.0993387** (0.0402397)
-0.1446617** (0.0722104)
-0.1312382*** (0.0470622)
-0.1798772* (0.1003406)
w/ 4Ps
w/ insurance - NOT SP
PhilHealth
0.0805385 (0.0966056)
0.0352155 (0.1150766)
0.048639 (0.1001861)
0.1798772* (0.1003406)
w/ 4Ps
w/ insurance -SP PhilHealth
0.0275072 (0.0374382)
-0.0178158 (0.0717761)
-0.0043923 (0.0431914)
0.1268458*** (0.0457448)
-0.0530313 (0.0995538)
Potential Outcome Mean
of Control Group
0.6509069*** (0.0227064)
0.6962299*** (0.064788)
0.6828064*** (0.0321329)
0.5515682*** (0.0346432)
0.7314454*** (0.0954248)
SUMMARY OF MAJOR FINDINGS
• Sponsored Program of PhilHealth alone does not significantly induce those with TB symptoms to seek treatment.
• 4Ps alone (without any type of insurance or SP PhilHealth) will not induce those with TB symptoms to seek treatment.
• Coupling of 4Ps and SP PhilHealth significantly induces those with TB symptoms to seek treatment by 12.68 percentage point higher chance compared to those with 4Ps alone.
POLICY IMPLICATIONS
•Package/complement 4Ps with health insurance to effectively protect the poorest and vulnerable from health shocks.
Thank you for listening!
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