The impact of filipino micro health-insurance units on income-related equality of access to healthcare.
BACKGROUND
This study aims to assess the impact of being insured by micro-health insurance units (MIUs) on equality of access to health care among groups with inequitable income distribution. We measure equality by relating income with access to healthcare. The analysis is based on a household survey conducted in five regions in the Philippines in 2002.


METHODS
We generated concentration curves and indices (CI) for insured and uninsured households (150 for each cohort in each region). We also elaborated a method to retain the relative income rank of households when data were aggregated across regions, as the regions had quite different nominal income levels.


RESULTS
We found a significant effect of household income on access to hospitalizations among the uninsured households (a positive CI), but no such effect among the insured households (CI close to zero). As regards professionally attended deliveries, an increased tendency of poorer households to deliver at home (CI slightly negative) and a lower rate of deliveries in hospital (CI slightly positive and statistically significant) were reported by both uninsured and insured households. Access to consultations was unrelated to income among the insured (CI close to 0), but negatively correlated with income among the uninsured (a positive and significant CI).


CONCLUSIONS
We conclude that MIUs in Philippines improve income-related equality of access to hospitalization and medical consultation in cases of illness. The findings of this study strengthen a claim for government support for the operation of MIUs as successful (albeit micro) suppliers of health insurance.
Dror
David Mark
DM
Erasmus University Rotterdam/MC, Institute for Health Policy and Management, Netherlands. daviddror@socialre.org
Koren
Ruth
R
Steinberg
David Mark
DM
D003430:Cross-Sectional Studies; D006297:Health Services Accessibility; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data*; D010679:Philippines; D012959:Socioeconomic Factors