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Health insurance benefit packages prioritized by low-income clients in India: Three criteria to estimate effectiveness of choice

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  • Dror, David Mark
  • Koren, Ruth
  • Ost, Alexander
  • Binnendijk, Erika
  • Vellakkal, Sukumar
  • Danis, Marion
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    Abstract

    We applied a decision tool for rationing choices, with a predetermined budget of about US$11 per household per year, to identify priorities of poor people regarding health insurance benefits in India in late 2005. A total of 302 individuals, organized in 24 groups, participated from a number of villages and neighborhoods of towns in Karnataka and Maharashtra. Many individuals were illiterate, innumerate and without insurance experience. Involving clients in insurance package design is based on an implied assumption that people can make judicious rationing decisions. Judiciousness was assessed by examining the association between the frequency of choosing a package and its perceived effectiveness. Perceived effectiveness was evaluated by comparing respondents' choices to the costs registered in 2049 illness episodes among a comparable cohort, using three criteria: 'reimbursement' (reimbursement regardless of the absolute level of expenditure), 'fairness' (higher reimbursement rate for higher expenses) and 'catastrophic coverage' (insurance for catastrophic exposure). The most frequently chosen packages scored highly on all three criteria; thus, rationing choices were confirmed as judicious. Fully 88.4% of the respondents selected at least three of the following benefits: outpatient, inpatient, drugs and tests, with a clear preference to cover high aggregate costs regardless of their probability. The results show that involving prospective clients in benefit package design can be done without compromising the judiciousness of rationing choices, even with people who have low education, low-income and no previous experience in similar exercises.

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    Bibliographic Info

    Article provided by Elsevier in its journal Social Science & Medicine.

    Volume (Year): 64 (2007)
    Issue (Month): 4 (February)
    Pages: 884-896

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    Handle: RePEc:eee:socmed:v:64:y:2007:i:4:p:884-896

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    Keywords: India Benefit package design Low-income population Rationing choices Access to healthcare Health insurance;

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    Cited by:
    1. Panda, P. & Chakraborty, A. & Dror, D.M. & Bedi, A.S., 2013. "Enrollment in community based health insurance schemes in rural Bihar and Uttar Pradesh, India," ISS Working Papers - General Series 555, International Institute of Social Studies of Erasmus University Rotterdam (ISS), The Hague.
    2. Victoria Fan & Anup Karan & Ajay Mahal, 2012. "State health insurance and out-of-pocket health expenditures in Andhra Pradesh, India," International Journal of Health Care Finance and Economics, Springer, vol. 12(3), pages 189-215, September.
    3. Victoria Fan, Anup Karan, and Anjay Mahal, 2012. "State Health Insurance and Out-of-Pocket Health Expenditures in Andhra Pradesh, India - Working Paper 298," Working Papers 298, Center for Global Development.
    4. Koen Rossel-Cambier, 2011. "Is Combined Microfinance an Instrument to enhance Sustainable Pro-Poor Public Policy Outcomes?," Working Papers CEB 11-013, ULB -- Universite Libre de Bruxelles.
    5. Faden, Laura & Vialle-Valentin, Catherine & Ross-Degnan, Dennis & Wagner, Anita, 2011. "Active pharmaceutical management strategies of health insurance systems to improve cost-effective use of medicines in low- and middle-income countries: A systematic review of current evidence," Health Policy, Elsevier, vol. 100(2), pages 134-143.
    6. Rama Pal, 2012. "Measuring incidence of catastrophic out-of-pocket health expenditure: with application to India," International Journal of Health Care Finance and Economics, Springer, vol. 12(1), pages 63-85, March.

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