title: Do Health Reforms to Improve Quality Have Long-Term Effects? Results of a Follow-Up on a Randomized Policy Experiment in the Philippines.
abstract: 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.
authors.affiliation: University of the Philippines, School of Economics, Manila, National Capital Region, Philippines.
authors.forename: Stella
authors.initials: S
authors.lastname: Quimbo
authors.affiliation: EUR, International Institute for Social Studies, The Hague, the Netherlands.
authors.forename: Natascha
authors.initials: N
authors.lastname: Wagner
authors.affiliation: University of the Philippines, School of Economics, Manila, National Capital Region, Philippines.
authors.forename: Jhiedon
authors.initials: J
authors.lastname: Florentino
authors.affiliation: University of the Philippines, School of Economics, Manila, National Capital Region, Philippines.
authors.forename: Orville
authors.initials: O
authors.lastname: Solon
authors.affiliation: University of California San Francisco, San Francisco, California, USA.
authors.forename: John
authors.initials: J
authors.lastname: Peabody
mesh_terms: D002662:Child Health Services; D002675:Child, Preschool; D005500:Follow-Up Studies; D018166:Health Care Reform / Q000191:economics*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007348:Insurance, Health; D015233:Models, Statistical; D010679:Philippines; D058996:Quality Improvement; D011787:Quality of Health Care / Q000191:economics; D012044:Regression Analysis; D012052:Reimbursement, Incentive / Q000191:economics*
keywords: health policy; health reform; policy experiment; quality improvement