IDEAS home Printed from https://ideas.repec.org/a/eee/hepoli/v95y2010i2-3p166-173.html
   My bibliography  Save this article

Efficiency, equity and feasibility of strategies to identify the poor: An application to premium exemptions under National Health Insurance in Ghana

Author

Listed:
  • Jehu-Appiah, Caroline
  • Aryeetey, Genevieve
  • Spaan, Ernst
  • Agyepong, Irene
  • Baltussen, Rob

Abstract

Objectives This paper outlines the potential strategies to identify the poor, and assesses their feasibility, efficiency and equity. Analyses are illustrated for the case of premium exemptions under National Health Insurance (NHI) in Ghana.Methods A literature search in Medline search was performed to identify strategies to identify the poor. Models were developed including information on demography and poverty, and costs and errors of in- and exclusion of these strategies in two regions in Ghana.Results Proxy means testing (PMT), participatory welfare ranking (PWR), and geographic targeting (GT) are potentially useful strategies to identify the poor, and vary in terms of their efficiency, equity and feasibility. Costs to exempt one poor individual range between US$11.63 and US$66.67, and strategies may exclude up to 25% of the poor. Feasibility of strategies is dependent on their aptness in rural/urban settings, and administrative capacity to implement. A decision framework summarizes the above information to guide policy making.Conclusions We recommend PMT as an optimal strategy in relative low poverty incidence urbanized settings, PWR as an optimal strategy in relative low poverty incidence rural settings, and GT as an optimal strategy in high incidence poverty settings. This paper holds important lessons not only for NHI in Ghana but also for other countries implementing exemption policies.

Suggested Citation

  • Jehu-Appiah, Caroline & Aryeetey, Genevieve & Spaan, Ernst & Agyepong, Irene & Baltussen, Rob, 2010. "Efficiency, equity and feasibility of strategies to identify the poor: An application to premium exemptions under National Health Insurance in Ghana," Health Policy, Elsevier, vol. 95(2-3), pages 166-173, May.
    • Handle: RePEc:eee:hepoli:v:95:y:2010:i:2-3:p:166-173
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0168-8510(09)00302-9
    Download Restriction: Full text for ScienceDirect subscribers only
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Julia Johannsen, 2006. "Operational Poverty Targeting In Peru – Proxy Means Testing With Non-Income Indicators," Working Papers 30, International Policy Centre for Inclusive Growth.
    2. Mozaffar Qizilbash, 2002. "A note on the measurement of poverty and vulnerability in the South African context," Journal of International Development, John Wiley & Sons, Ltd., vol. 14(6), pages 757-772.
    3. Minot, Nicholas, 2000. "Generating Disaggregated Poverty Maps: An Application to Vietnam," World Development, Elsevier, vol. 28(2), pages 319-331, February.
    4. Chaudhuri, Shubham & Ravallion, Martin, 1994. "How well do static indicators identify the chronically poor?," Journal of Public Economics, Elsevier, vol. 53(3), pages 367-394, March.
    5. Mark Montgomery & Paul Hewett, 2005. "Urban poverty and health in developing countries: Household and neighborhood Effects," Demography, Springer;Population Association of America (PAA), vol. 42(3), pages 397-425, August.
    6. Chris Elbers & Jean O. Lanjouw & Peter Lanjouw, 2003. "Micro--Level Estimation of Poverty and Inequality," Econometrica, Econometric Society, vol. 71(1), pages 355-364, January.
    7. Grosh, M.E. & Baker, J.L., 1995. "Proxy Means Tests for Targetting Social Programs. Simulations and Speculation," Papers 118, World Bank - Living Standards Measurement.
    8. Ravallion, Martin, 1996. "Issues in Measuring and Modelling Poverty," Economic Journal, Royal Economic Society, vol. 106(438), pages 1328-1343, September.
    9. Bigman, David, et al, 2000. "Community Targeting for Poverty Reduction in Burkina Faso," The World Bank Economic Review, World Bank, vol. 14(1), pages 167-193, January.
    10. Ben D. MacArthur & Richard O. C. Oreffo, 2005. "Bridging the gap," Nature, Nature, vol. 433(7021), pages 19-19, January.
    11. Caroline Dewilde, 2004. "The Multidimensional Measurement of Poverty in Belgium and Britain: A Categorical Approach," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 68(3), pages 331-369, September.
    12. François Bourguignon & Satya R. Chakravarty, 2019. "The Measurement of Multidimensional Poverty," Themes in Economics, in: Satya R. Chakravarty (ed.), Poverty, Social Exclusion and Stochastic Dominance, pages 83-107, Springer.
    13. Ravallion, M., 1992. "Poverty Comparisons - A Guide to Concepts and Methods," Papers 88, World Bank - Living Standards Measurement.
    14. Kraybill, David S. & Bashaasha, Bernard, 2006. "The potential gains from geographical targeting of anti-poverty programs in Uganda," African Journal of Agricultural and Resource Economics, African Association of Agricultural Economists, vol. 1(1), pages 1-12, December.
    15. Celia M. Reyes, 2006. "Alternative Means Testing Options Using CBMS," Development Economics Working Papers 22685, East Asian Bureau of Economic Research.
    16. Morris, Saul S. & Levin, Carol E. & Armar-Klemesu, Margaret & Maxwell, Daniel & Ruel, Marie T., 1999. "Does Geographic Targeting of Nutrition Interventions Make Sense in Cities? Evidence from Abidjan and Accra," World Development, Elsevier, vol. 27(11), pages 2011-2019, November.
    17. Castaneda, Tarsicio & Lindert, Kathy & de la Briere, Benedicte & Fernandez, Luisa & Hubert, Celia & Larranaya, Oswaldo & Orozco, Monica & Viquez, Roxana, 2005. "Designing and implementing household targeting systems : lessons from Latin American and The United States," Social Protection Discussion Papers and Notes 32756, The World Bank.
    18. Elbers, Chris & Fujii, Tomoki & Lanjouw, Peter & Ozler, Berk & Yin, Wesley, 2007. "Poverty alleviation through geographic targeting: How much does disaggregation help?," Journal of Development Economics, Elsevier, vol. 83(1), pages 198-213, May.
    19. David E. Sahn & David Stifel, 2003. "Exploring Alternative Measures of Welfare in the Absence of Expenditure Data," Review of Income and Wealth, International Association for Research in Income and Wealth, vol. 49(4), pages 463-489, December.
    20. Kanbur, Ravi, 2002. "Conceptual Challenges In Poverty And Inequality:One Development Economist'S Perspective," Working Papers 7242, Cornell University, Department of Applied Economics and Management.
    21. Hentschel, Jesko, et al, 2000. "Combining Census and Survey Data to Trace the Spatial Dimensions of Poverty: A Case Study of Ecuador," The World Bank Economic Review, World Bank, vol. 14(1), pages 147-165, January.
    22. Ravallion, Martin, 1994. "Measuring Social Welfare with and without Poverty Lines," American Economic Review, American Economic Association, vol. 84(2), pages 359-364, May.
    23. Björn Gustafsson & Li Shi & Hiroshi Sato, 2004. "Can a subjective poverty line be applied to China? Assessing poverty among urban residents in 1999," Journal of International Development, John Wiley & Sons, Ltd., vol. 16(8), pages 1089-1107.
    24. Chen, Shaohua & Ravallion, Martin, 2007. "Absolute poverty measures for the developing world, 1981-2004," Policy Research Working Paper Series 4211, The World Bank.
    25. Reyes, Celia M., 2006. "Alternative Means Testing Options Using CBMS," Discussion Papers DP 2006-22, Philippine Institute for Development Studies.
    26. Ravallion, Martin & Sen, Binayak, 1996. "When Method Matters: Monitoring Poverty in Bangladesh," Economic Development and Cultural Change, University of Chicago Press, vol. 44(4), pages 761-792, July.
    27. Sharif, Iffath A., 2009. "Building a targeting system for Bangladesh based on proxy means testing," Social Protection Discussion Papers and Notes 50670, The World Bank.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Jenna Dixon & Eric Y Tenkorang & Isaac Luginaah, 2011. "Ghana's National Health Insurance Scheme: Helping the Poor or Leaving Them Behind?," Environment and Planning C, , vol. 29(6), pages 1102-1115, December.
    2. Dubois, Ute, 2012. "From targeting to implementation: The role of identification of fuel poor households," Energy Policy, Elsevier, vol. 49(C), pages 107-115.
    3. Shono, Aiko & Kondo, Masahide & Ohmae, Hiroshi & Okubo, Ichiro, 2014. "Willingness to pay for public health services in rural Central Java, Indonesia: Methodological considerations when using the contingent valuation method," Social Science & Medicine, Elsevier, vol. 110(C), pages 31-40.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Benjamin Davis, 2002. "Is it possible to avoid a lemon? Reflections on choosing a poverty mapping method," Working Papers 02-07, Agricultural and Development Economics Division of the Food and Agriculture Organization of the United Nations (FAO - ESA).
    2. Nicholas Minot & Bob Baulch, 2005. "Poverty Mapping with Aggregate Census Data: What is the Loss in Precision?," Review of Development Economics, Wiley Blackwell, vol. 9(1), pages 5-24, February.
    3. Mark Schreiner, 2015. "A Comparison of Two Simple, Low-Cost Ways for Local, Pro-Poor Organizations to Measure the Poverty of Their Participants," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 124(2), pages 537-569, November.
    4. Anh Thu Quang Pham & Pundarik Mukhopadhaya & Ha Vu, 2020. "Targeting Administrative Regions for Multidimensional Poverty Alleviation: A Study on Vietnam," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 150(1), pages 143-189, July.
    5. Sung-Geun Kim, 2015. "Fuzzy Multidimensional Poverty Measurement: An Analysis of Statistical Behaviors," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 120(3), pages 635-667, February.
    6. Frank-Borge Wietzke, 2015. "Who Is Poorest? An Asset-based Analysis of Multidimensional Wellbeing," Development Policy Review, Overseas Development Institute, vol. 33(1), pages 33-59, January.
    7. John A. Maluccio, 2009. "Household targeting in practice: The Nicaraguan Red de Protección Social," Journal of International Development, John Wiley & Sons, Ltd., vol. 21(1), pages 1-23.
    8. F. le R. Booysen, 2001. "Non‐Payment Of Services: A Problem Of Ability‐To‐Pay," South African Journal of Economics, Economic Society of South Africa, vol. 69(4), pages 674-697, December.
    9. Kiran, Rubina & Jabbar, Abdul, 2022. "Policy-oriented food insecurity estimation and mapping at district level in Pakistan," Agricultural and Resource Economics: International Scientific E-Journal, Agricultural and Resource Economics: International Scientific E-Journal, vol. 8(4), December.
    10. Norbert R. Schady, 2002. "Picking the Poor: Indicators for Geographic Targeting in Peru," Review of Income and Wealth, International Association for Research in Income and Wealth, vol. 48(3), pages 417-433, September.
    11. Simler, Kenneth R., 2006. "Nutrition mapping in Tanzania: an exploratory analysis," FCND discussion papers 204, International Food Policy Research Institute (IFPRI).
    12. Channing Arndt & Azhar M. Hussain & Vincenzo Salvucci & Finn Tarp & Lars Peter Østerdal, 2016. "Poverty Mapping Based on First‐Order Dominance with an Example from Mozambique," Journal of International Development, John Wiley & Sons, Ltd., vol. 28(1), pages 3-21, January.
    13. Graw, Valerie & Husmann, Christine Ladenburger, 2012. "Mapping Marginality Hotspots – Geographical Targeting for Poverty Reduction," Working Papers 147917, University of Bonn, Center for Development Research (ZEF).
    14. Arouri, Mohamed & Nguyen, Cuong & Youssef, Adel Ben, 2015. "Natural Disasters, Household Welfare, and Resilience: Evidence from Rural Vietnam," World Development, Elsevier, vol. 70(C), pages 59-77.
    15. Hyman, Glenn & Larrea, Carlos & Farrow, Andrew, 2005. "Methods, results and policy implications of poverty and food security mapping assessments," Food Policy, Elsevier, vol. 30(5-6), pages 453-460.
    16. Simler, Kenneth R. & Nhate, Virgulino, 2005. "Poverty, inequality, and geographic targeting: Evidence from Small-Area Estimates in Mozambique," FCND discussion papers 192, International Food Policy Research Institute (IFPRI).
    17. Minot, Nicholas & Baulch, Bob, 2005. "Spatial patterns of poverty in Vietnam and their implications for policy," Food Policy, Elsevier, vol. 30(5-6), pages 461-475.
    18. Jing Dai & Stefan Sperlich & Walter Zucchini, 2011. "Estimating and Predicting Household Expenditures and Income Distributions," MAGKS Papers on Economics 201147, Philipps-Universität Marburg, Faculty of Business Administration and Economics, Department of Economics (Volkswirtschaftliche Abteilung).
    19. Claudio A. Agostini & Philip H. Brown, 2010. "Local Distributional Effects Of Government Cash Transfers In Chile," Review of Income and Wealth, International Association for Research in Income and Wealth, vol. 56(2), pages 366-388, June.
    20. Barrios, Erniel B. & Mina, Christian D., 2009. "Profiling Poverty with Multivariate Adaptive Regression Splines," Discussion Papers DP 2009-29, Philippine Institute for Development Studies.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:hepoli:v:95:y:2010:i:2-3:p:166-173. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu or the person in charge (email available below). General contact details of provider: http://www.elsevier.com/locate/healthpol .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.