The Effect of Consensus on Demand for Voluntary Micro Health Insurance in Rural India (original) (raw)
Related papers
The Demand for (Micro) Health Insurance in the Informal Sector
The Geneva Papers on Risk and Insurance Issues and Practice, 2014
We identify the need for a theory of demand for health insurance suited to the informal sector in low-and middle income countries (LMIC) where some 3 billion people lack health cover. Excluded from formal governance structures, they rely on informal arrangements by which rulesin-use shape choices, behaviours and decisions. We explore the fundamental assumptions of standard economic theories of demand for health insurance in the light of arguments from the literature and field evidence. We show that the assumptions are largely inconsistent with the context of poverty and informality. And we propose a new theory based on assumptions better suited to the context of informality and poverty. Our major conclusion is that, in order to grow the demand for health insurance in the informal sector in LMIC, it is first necessary to strengthen ground-up governance consistent with group-based decision-making under local conditions.
This study deals with consensus by poor persons in the informal sector in rural India on the benefit-package of their community-based health insurance (CBHI). In this article we describe the process of involving rural poor in benefit-package design and assess the underlying reasons for choices they made and their ability to reach group consensus. Methods: The benefit-package selection process entailed four steps: narrowing down the options by community representatives, plus three Choosing Healthplans All Together (CHAT) rounds conducted among female members of self-help groups. We use mixed-methods and four sources of data: baseline study, CHAT exercises, in-depth interviews, and evaluation questionnaires. We define consensus as a community resolution reached by discussion, considering all opinions, and to which everyone agrees. We use the coefficient of unalikeability to express consensus quantitatively (as variability of categorical variables) rather than just categorically (as a binomial Yes/No). Findings: The coefficient of unalikeability decreased consistently over consecutive CHAT rounds, reaching zero (ie, 100% consensus) in two locations, and confirmed gradual adoption of consensus. Evaluation interviews revealed that the wish to be part of a consensus was dominant in all locations. The in-depth interviews indicated that people enjoyed the participatory deliberations, were satisfied with the selection, and that group decisions reflected a consensus rather than majority. Moreover, evidence suggests that pre-selectors and communities aimed to enhance the likelihood that many households would benefit from CBHI. Conclusion: The voluntary and contributory CBHI relies on an engaging experience with others to validate perceived priorities of the target group. The strongest motive for choice was the wish to join a consensus (more than price or package-composition) and the intention that many members should benefit. The degree of consensus improved with iterative CHAT rounds. Harnessing group consensus requires catalytic intervention, as the process is not spontaneous.
London: EPPI-Centre, Social Science Research Unit, Institute of Education, University of London, 2013
"The penetration of commercial or public contributory health insurance to the informal sector is very poor and the scaling of successful local interventions of Community-based health insurance (CBHI) seems to be one of the promising approaches to remedy this situation. However, the existing information about the determinants of such success is lacking. There is no coherent understanding of an ideal way to implement and sustain such local efforts. Lately, there has been a proliferation of thinking about the demand for insurance and medical care, and some attempts have been made to understand demand for voluntary health insurance like CBHI in low-income countries (ILO, 2002).There seems to be few literatures pertaining to the patterns of uptake of such insurance. Evidence on determinants of enrolment with CBHI comes mostly from recent econometric modelling to predict influences of individual and household characteristics on enrolment decisions (Ito and Kono, 2010; Morsink and Geurts, 2011; Bonan et al., 2012). A few qualitative studies inform and complement studies on determinants of enrolment (Criel and Waelkens, 2003; De Allegri et al., 2006; Basaza et al., 2008), while others used mixed method approaches (Ozawa and Walker, 2009). The research question for the proposed systematic review is the identification of key parameters that determine the uptake of voluntary and community-based health insurance in low- and middle-income countries. Our review will also cover factors affecting re-enrolment in CBHI schemes. We will follow a search strategy, using online databases related to thematic areas in the objective including social science, economics and medical science. We will search specific electronic databases which will be further supplemented by hand searching, citation tracking, and personal communication including grey literature. The determinants of CBHI uptake would be assessed using a broad evidence base (including both quantitative and qualitative). We plan on using the PROGRESS-Plus framework of Kavanagh et al. (2008) so as to interpret the data through an equity lens viz. Place of Residence, Ethnicity, Occupation, Gender, Religion, Education, Social Capital (including peer experience with insurance, and specifically claims), Socio-economic position (SEP), Age, Disability, Sexual orientation, other vulnerable groups (e.g. disabled, HIV/AIDS, etc.). We will supplement this with topic-specific determinants such as previous exposure to insurance, having followed insurance education campaigns, and financial literacy in general (i.e. previous experience with microfinance in the broad sense – credit and savings). For all included studies in addition to describing their study design, we will also assess their quality. We will assess the quality of included studies using checklist (Waddington et al., 2012), making judgments on the adequacy of reporting, data collection, presentation, analysis and conclusions drawn. It is important to assess the methodological quality of individual studies (i.e. validity assessment) as it may affect both the results of the individual studies and ultimately the conclusions reached from the body of studies. A success of this project is also linked to our ability to collecting the information that is scattered in many data sources, analysis of the data and translation of this analysis to a set of coherent general guidelines for successful implementation of voluntary health insurance among the poor in low income countries. Through the identification of groups particularly within South and South East Asia that are working on CBHI as well as through the course of the review; We aim to emphasize the creation of knowledge translation tools e.g. websites, policy briefs, newspapers, articles that can reach the end-line users such as policy-makers, donors and civil society organizations through conference presentations, policy briefs and contributing to the updating and maintenance of existing webpages. This would be enabled by an advisory group comprising of policy-makers, donors, methodology expert and other researchers active in the area of initiatives for pro-poor insurance coverage in LMIC."
Demand for voluntary health insurance by the poor in developing countries: Evidence from rural Ghana
CEA 37th Annual Meetings, Ottawa: Carleton …, 2003
In recent years the number of formal risk-sharing schemes for health care services in Ghana has risen rapidly. At present about 42 out of 110 districts are operating some form of formal community-based health insurance, which are voluntary and to a greater extent integrated to health care facilities. The success of these schemes depend largely on the extent to which they directly or indirectly lessen the financial burden of people who have suffered most since the inception of economic reforms in the health sector. The paper looked at the social inclusion aspects of the schemes by studying demand for the two oldest schemes by the poor and exploring design features that could enhance better coverage and improve financial protection for health care services. The findings portray a remarkable exclusion of the poorest of the poor, even from other forms of risk-sharing arrangements in the informal sector. The paper also identifies limitation on plan choice as a constraining factor and highlights redirection of subsidies from urban areas to favour rural health infrastructure. 2 Evolving health insurance schemes in Ghana Different actors finance the health care system in Ghana: government of Ghana through direct budget allocation and local government common fund; households, non-governmental organisations (NGOs) that assist religious hospitals and clinics; and the donor community. 1 Informal risk sharing involves mutual support network of members of a community, extended household, or ethnic groups; among members of the same occupation; or between migrants of similar origin (Criel, 1998; Atim, 1999; World Bank, 2000). Those that provide any health related benefit is referred to as informal health insurance scheme in this paper. By formal health insurance scheme, the paper includes private health insurance schemes, hospital-based health insurance schemes and well-organised form of group-based associations, which are primarily setup for medical insurance.
2007
Limited funding dictates that health insurance for low-income persons would compensate only part of healthcare needs. Existing health insurance products in India are too restrictive to be attractive to low-income & rural populations. We hypothesize that attractive health insurance must represent an optimum match between clients' needs for health care, demand for health insurance, and available supply of health care. Based on data from a household survey among rural poor and urban slum dwellers in seven locations in India collected in 2005, we provide evidence of marked differences across locations in all three parameters: solvent demand for health insurance (proxy: willingness to pay), medical needs (proxy: frequency of illness episodes and the number of days of illness per HH), and the supply of healthcare (proxy: type of healthcare provider and outof-pocket expenditure on health care). We also show that aggregated expenses of consultations and drugs exceed those of hospitalizations in all locations. We conclude that because the variations in clients' needs, cost of healthcare, availability of services and clients' demand for health insurance across locations cannot be optimized in a single partial benefit package, a context-specific solution is needed to be relevant in each location. (3144 words)
Factors leading to decreasing demand for Community Health Insurance among urban informal sector
Community based health insurance although being seen as a proper approach for the poor to have access to health services; its demand has been decreasing in many developing countries. This study was focused onto finding out "factors leading to decreasing demand for community based health insurance among urban informal sector", the case of Dar es Salaam. The objectives of the study were: Factors leading to decreasing demand for Community Health Insurance among urban informal sector xv APPENDICES Appendix No.1: questionnaire for members, management and provider 94 Appendix No.
Health Insurance for the Informal Sector: Problems and Prospects
2000
and Argentina, is undertaken with a view to drawing lessons for India. On the basis of a pilot study undertaken in Gujarat during 1999, the paper examines the feasibility of providing health insurance to poor people in terms of both willingness and capacity to pay for such services. The paper also suggests various options available to introduce an affordable health insurance plan for workers in the informal sector. The issues discussed in this paper have assumed great importance in the current context of liberalisation of the insurance sector in India. Health insurance will continue to remain a high priority area in the years to come. I am confident that this paper by Dr Anil Gumber will provide an important contribution to the challenging task of developing and marketing of an affordable health insurance package for low-income people.
Health Policy, 2007
This study, conducted in India in 2005, provides evidence on Willingness to pay (WTP), gathered through a unidirectional (descending) bidding game among 3024 households (HH) in seven locations where micro health insurance units are in operation. Insured persons reported slightly higher WTP values than uninsured. About two-thirds of the sample agreed to pay at least 1%; about half the sample was willing to pay at least 1.35%; 30% was willing to pay about 2.0% of annual HH income as health insurance premium. Nominal WTP correlates positively with income but relative WTP (expressed as percent of HH income) correlates negatively. The correlation between WTP and education is secondary to that of WTP with HH income. Household composition did not affect WTP. However, HHs that experienced a high-cost health event and male respondents reported slightly higher WTP. The observed nominal levels of WTP are higher than has been estimated hitherto.
Enrolment in community-based health insurance schemes in rural Bihar and Uttar Pradesh, India
Health policy and planning, 2013
This article assesses insurance uptake in three community-based health insurance (CBHI) schemes located in rural parts of two of India's poorest states and offered through women's self-help groups (SHGs). We examine what drives uptake, the degree of inclusive practices of the schemes and the influence of health status on enrolment. The most important finding is that a household's socio-economic status does not appear to substantially inhibit uptake. In some cases scheduled caste/scheduled tribe households are more likely to enrol. Second, households with greater financial liabilities find insurance more attractive. Third, access to the national hospital insurance scheme Rashtriya Swasthya Bima Yojana does not dampen CBHI uptake, suggesting that the potential for greater development of insurance markets and products beyond existing ones would respond to a need. Fourth, recent episodes of illness and self-assessed health status do not influence uptake. Fifth, insurance coverage is prioritized within households, with the household head, the spouse of the household head and both male and female children of the household head, more likely to be insured as compared with other relatives. Sixth, offering insurance through women's SHGs appears to mitigate concerns about the inclusiveness and sustainability of CBHI schemes. Given the pan-Indian spread of SHGs, offering insurance through such groups offers the potential to scale-up CBHI.