Chronic disease, healthcare use, financial protection and disability in the Philippines

We will conduct an evaluation to assess the impact of three interventions intended to address demand- and supply-side deficiencies that are likely to constrain the effectiveness of the “Appropriate Services for Family Health” program (Tsekap) in its current design. The interventions are as follows:

a) Vouchers to cover transportation costs for screening for hypertension, diabetes and dyslipidemia. Vouchers will be provided to randomly selected households in treatment sites with Philhealth members aged > 30 years who qualify for the Tsekap program. The vouchers will cover transportation to a health facility for screening. Vouchers will be distributed through the enumerators of a baseline survey. Agreements with organized transport groups in the locality (i.e. of “jeepney” and “tricycle” drivers) will be secured so that they will provide transport services in exchange for the vouchers. The transport operators can exchange these vouchers for cash in the health facilities. When designing the voucher system, we will build safeguards to mitigate adverse responses such as using the transport vouchers for other travels or trading. The vouchers will be financed from the project budget.

b) Travel vouchers for continued medication of the three aforementioned conditions. Transportation vouchers will be provided to selected individuals who are diagnosed with hypertension, diabetes mellitus or dyslipidemia to enable them to go to the facility for monitoring visits and to pick-up their prescriptions from partner pharmacies. Individuals to be given the transportation vouchers will be selected by the healthcare provider on the basis of (1) place of residence and (2) poverty status. Providers will be guided by a list of areas considered distant on the basis of the estimated time of travel to the facility. These lists will be pre-generated by the study team. The healthcare provider will also consider the ability of the patient to shoulder the cost of transport using easily verifiable indicators such as PhilHealth membership type or conditional cash transfer program eligibility.

c) Provider payments linked to monitoring of patients’ medication adherence for the aforementioned conditions. A bonus payment of Php 50,000 (about USD 1,200) per facility per year in intervention municipalities will be paid conditional on meeting targets for medication and control of the three conditions. A preliminary design of the targets is as follows: (1) 75% of diagnosed patients appearing for monitoring check-ups, (2) 75% of diagnosed patients picking up their medication from partner pharmacies, and (3) 50% of diagnosed patients with controlled blood pressure and blood glucose level. The final structure and levels of the targets will be determined after observation of the Tsekap operation in the first year of the project.