Health conditions, payments, proximity, and opportunity costs: Examining delays in seeking inpatient and outpatient care in the Philippines.

Like other developing countries, the Philippines commits to achieving universal health coverage. To identify the factors - including health care needs, financial and physical access, and opportunity costs - associated with delays in seeking outpatient (OP) and inpatient (IP) care among household members with illness, injury or advised by a doctor, this paper estimates Cox and Weibull proportional hazard models using a nationally-representative sample of households surveyed in 2011, when the Philippine government just started implementing major health reforms. Our results indicate that the delays in seeking OP care tend to be shorter for the very young (5 years old or below), the elderly (65 years old or above), and those with prior poor health. Similarly, delays in seeking IP care tend to be shorter among the very young and those requiring maternity services. Moreover, having a college-educated head of household is associated with shorter delays in seeking OP and IP care. Delays in seeking OP care are shorter in the National Capital Region than in other regions, but longer OP delays are associated with presence of a nearby public health facility. Deferrals in seeking IP care are shorter and delays in seeking OP care are longer when the sick or injured member is employed. When the spouse of the household head is employed, IP care is likewise postponed further. Relative to the poorest income quintile, the second- and third-income quintiles tarry longer. Last, insurance coverage and urban location are not found to be significant correlates. To enhance the effectiveness of recent reforms on utilization, these results suggest deepening the awareness of the covered population of their insurance benefits or to monitor the quality of local health facilities, especially that received grants. Labor policies that reduce the opportunity cost of seeking care among the employed may also be considered.

Cooking and coughing: Estimating the effects of clean fuel for cooking on the respiratory health of children in the Philippines.

Household air pollution (HAP) arising from the use of solid fuels for cooking is known to have adverse health effects including acute respiratory infections in children, which remains a major public health concern in developing countries. Hence, various interventions to reduce HAP have been advocated or piloted in many countries. To provide additional evidence on the effectiveness and applicability of the interventions in various settings, we investigate the effects of clean fuel for cooking on the risks of respiratory illness of children below five years old in the Philippines. We apply the propensity score matching method on a subsample of households culled from the 2013 round of the National Demographic and Health Survey to account for the systematic differences in their characteristics that could influence their choices of cooking fuel. We find that the use of electricity, liquefied petroleum gas, natural gas or biogas can lower by 2.4 percentage points the incidence of severe coughing with difficulty in breathing in young children. Our results support worldwide initiatives to promote the household use of clean fuels for cooking and heating to reduce HAP and its undesirable impacts on population health.

Do piped water and flush toilets prevent child diarrhea in rural Philippines?

Similar to other developing countries, diarrhea in the Philippines continues to be among the top causes of child mortality and morbidity. In pursuit of its Millennium Development Goals, the Philippine government commits to reduce child deaths and provide water and sanitation services to more rural households by 2015. Applying propensity score matching on the 1993, 1998, 2003, and 2008 rounds of the National Demographic and Health Survey to estimate the average treatment effect on the treated, it is found that the incidence of diarrhea among under-5 children is lower by as much as 4.5% in households with access to piped water and 10% in those with their own flush toilets, relative to comparable households. These findings underscore the need to ensure the quality of drinking water from the pipe or from other improved sources at the point of use, and the provision of improved and own sanitation facilities.