An evaluation of the cost-effectiveness of policy navigators to improve access to care for the poor in the Philippines.
OBJECTIVE
Even when health insurance coverage is available, health policies may not be effective at increasing coverage among vulnerable populations. New approaches are needed to improve access to care. We experimentally introduced a novel intervention that uses Policy Navigators to increase health insurance enrollment in a poor population.


METHODS
We used data from the Quality Improvement Demonstration Study (QIDS), a randomized experiment taking place at the district level in the Visayas region of the Philippines. In two arms of the study, we compared the effects of introducing Policy Navigators to controls. The Policy Navigators advocated for improved access to care by providing regular system-level expertise directly to the policy-makers, municipal mayors and governors responsible for paying for and enrolling poor households into the health insurance program. Using regression models, we compared levels of enrollment in our intervention versus control sites. We also assessed the cost-effectiveness of marginal increases in enrollment.


RESULTS
We found that Policy Navigators improved enrollment in health insurance between 39% and 102% compared to the controls. Policy navigators were cost-effective at 0.86 USD per enrollee. However, supplementary national government campaigns, which were implemented to further increase coverage, attenuated normal enrollment efforts.


CONCLUSIONS
Policy Navigators appear to be effective in improving access to care and their success underscores the importance of local-level strategies for improving enrollment.
University of the Philippines, School of Economics, Diliman, Philippines.
Orville
O
Solon
John W
JW
Peabody
Kimberly
K
Woo
Stella A
SA
Quimbo
Jhiedon
J
Florentino
Riti
R
Shimkhada
D003362:Cost-Benefit Analysis; D003627:Data Interpretation, Statistical; D018166:Health Care Reform; D006291:Health Policy; D006297:Health Services Accessibility / Q000191:economics*; D006801:Humans; D019458:Insurance Coverage / Q000331:legislation & jurisprudence; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008137:Longitudinal Studies; D010679:Philippines; D011203:Poverty; D011314:Preventive Health Services; D015397:Program Evaluation; D012044:Regression Analysis; D012052:Reimbursement, Incentive / Q000331:legislation & jurisprudence