Objectives: Adequate prenatal and delivery care are vital components of successful maternal health care provision. Starting in 1998, two programs were widely expanded in the Philippines: a national health insurance program (PhilHealth); and a donor-funded franchise of midwife clinics (Well Family Midwife Clinics). This paper examines population-level impacts of these interventions on achievement of minimum standards for prenatal and delivery care. Methods: Data from two waves of the Demographic and Health Surveys, conducted before (1998) and after (2003) scale-up of the interventions, are employed in a pre/post-study design, using longitudinal multivariate logistic and linear regression models. Results: After controlling for demographic and socioeconomic characteristics, the PhilHealth insurance program scale-up was associated with increased odds of receiving at least four prenatal visits (OR 1.04 [95% CI 1.01-1.06]) and receiving a visit during the first trimester of pregnancy (OR 1.03 [95% CI 1.01-1.06]). Exposure to midwife clinics was not associated with significant changes in achievement of prenatal care standards. While both programs were associated with slight increases in the odds of delivery in a health facility, these increases were not statistically significant. Conclusions: These results suggest that expansion of an insurance program with accreditation standards was associated with increases in achievement of minimal standards for prenatal care among women in the Philippines.
Bibliographical noteFunding Information:
This study benefited greatly from the input of Bernard Harlow, Haiden Huskamp, Michael Law, Stephen Soumerai, and Alan Zaslavsky. This work was completed as part of the first author's doctoral dissertation for the Harvard University Ph.D. Program in Health Policy. Funding was provided by the Fellowship in Pharmaceutical Policy Research at the Department of Ambulatory Care and Prevention at Harvard Medical School, a T32 institutional pre-doctoral training grant from the Agency for Healthcare Research and Quality to Harvard University, and a Harvard University Dissertation Completion Grant.
- Maternal health
- National health insurance program
- Prenatal and delivery care
- Social franchising