IDEAS home Printed from https://ideas.repec.org/a/pal/gpprii/v44y2019i3d10.1057_s41288-018-00115-5.html
   My bibliography  Save this article

Promoting sustainability for micro health insurance: a risk-adjusted subsidy approach for maternal healthcare service

Author

Listed:
  • Yi Yao

    (Peking University)

  • Joan Schmit

    (University of Wisconsin at Madison)

  • Julie Shi

    (Peking University)

Abstract

Micro health insurance is an important way to finance health expenditure for low-income people, and maternity care is a key component of relevant coverage. We propose a risk-adjusted subsidy provided by the government to microinsurers as a method to enhance micro health insurance for maternity benefits. Using a large data set from a micro health insurance programme in Pakistan, we apply various econometric models to predict maternity-related expenses and to calculate an appropriate risk-adjusted subsidy from the government to microinsurer. This allows us to further simulate the microinsurers’ financial results. We find that the risk-adjusted subsidy could significantly improve the loss ratio by almost 40%, and the Ordinary Least Squares model is preferred among the four model forms we test. We contribute to the literature by demonstrating that this method is feasible, and further, by illustrating the potential effect of such a subsidy on micro health insurer outcomes. If successful, such a payment model could improve efficiency and extend affordable maternity care to low-income women in developing regions.

Suggested Citation

  • Yi Yao & Joan Schmit & Julie Shi, 2019. "Promoting sustainability for micro health insurance: a risk-adjusted subsidy approach for maternal healthcare service," The Geneva Papers on Risk and Insurance - Issues and Practice, Palgrave Macmillan;The Geneva Association, vol. 44(3), pages 382-409, July.
    • Handle: RePEc:pal:gpprii:v:44:y:2019:i:3:d:10.1057_s41288-018-00115-5
    DOI: 10.1057/s41288-018-00115-5
    as

    Download full text from publisher

    File URL: http://link.springer.com/10.1057/s41288-018-00115-5
    File Function: Abstract
    Download Restriction: Access to full text is restricted to subscribers.
    File URL: https://libkey.io/10.1057/s41288-018-00115-5?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    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. Jason Brown & Mark Duggan & Ilyana Kuziemko & William Woolston, 2014. "How Does Risk Selection Respond to Risk Adjustment? New Evidence from the Medicare Advantage Program," American Economic Review, American Economic Association, vol. 104(10), pages 3335-3364, October.
    2. Andrew M. Jones & James Lomas & Nigel Rice, 2014. "Applying Beta‐Type Size Distributions To Healthcare Cost Regressions," Journal of Applied Econometrics, John Wiley & Sons, Ltd., vol. 29(4), pages 649-670, June.
    3. Mullahy, John, 1998. "Much ado about two: reconsidering retransformation and the two-part model in health econometrics," Journal of Health Economics, Elsevier, vol. 17(3), pages 247-281, June.
    4. John Mullahy, 1998. "Much Ado About Two: Reconsidering Retransformation and the Two-Part Model in Health Economics," NBER Technical Working Papers 0228, National Bureau of Economic Research, Inc.
    5. Shen, Yujing & Ellis, Randall P., 2002. "Cost-minimizing risk adjustment," Journal of Health Economics, Elsevier, vol. 21(3), pages 515-530, May.
    6. Jones, A. M. & Lomas, J. & Moore, P. & Rice, N., 2013. "A quasi-Monte Carlo comparison of developments in parametric and semi-parametric regression methods for heavy tailed and non-normal data: with an application to healthcare costs," Health, Econometrics and Data Group (HEDG) Working Papers 13/30, HEDG, c/o Department of Economics, University of York.
    7. Martin Eling & Ruo Jia & Yi Yao, 2017. "Between-Group Adverse Selection: Evidence From Group Critical Illness Insurance," Journal of Risk & Insurance, The American Risk and Insurance Association, vol. 84(2), pages 771-809, June.
    8. Thomas G. McGuire & Jacob Glazer, 2000. "Optimal Risk Adjustment in Markets with Adverse Selection: An Application to Managed Care," American Economic Review, American Economic Association, vol. 90(4), pages 1055-1071, September.
    9. Wang, Hong & Zhang, Licheng & Yip, Winnie & Hsiao, William, 2006. "Adverse selection in a voluntary Rural Mutual Health Care health insurance scheme in China," Social Science & Medicine, Elsevier, vol. 63(5), pages 1236-1245, September.
    10. Karen Eggleston & Anupa Bir, 2009. "Measuring Selection Incentives in Managed Care: Evidence From the Massachusetts State Employee Insurance Program," Journal of Risk & Insurance, The American Risk and Insurance Association, vol. 76(1), pages 159-175, March.
    11. Leemore S. Dafny, 2005. "How Do Hospitals Respond to Price Changes?," American Economic Review, American Economic Association, vol. 95(5), pages 1525-1547, December.
    12. Geruso, Michael & McGuire, Thomas G., 2016. "Tradeoffs in the design of health plan payment systems: Fit, power and balance," Journal of Health Economics, Elsevier, vol. 47(C), pages 1-19.
    13. Andrew M. Jones & James Lomas & Peter T. Moore & Nigel Rice, 2016. "A quasi-Monte-Carlo comparison of parametric and semiparametric regression methods for heavy-tailed and non-normal data: an application to healthcare costs," Journal of the Royal Statistical Society Series A, Royal Statistical Society, vol. 179(4), pages 951-974, October.
    14. Van de ven, Wynand P.M.M. & Ellis, Randall P., 2000. "Risk adjustment in competitive health plan markets," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 14, pages 755-845, Elsevier.
    15. Ralf Radermacher & Siddharth Srivastava & Matthew Walsham & Chhorn Sao & Francesco Paolucci, 2016. "Enhancing the Inclusion of Vulnerable and High-Risk Groups in Demand-Side Health Financing Schemes in Cambodia: A Concept for a Risk-Adjusted Subsidy Approach," The Geneva Papers on Risk and Insurance - Issues and Practice, Palgrave Macmillan;The Geneva Association, vol. 41(2), pages 244-258, April.
    16. Schokkaert, Erik & Van de Voorde, Carine, 2003. "Belgium: risk adjustment and financial responsibility in a centralised system," Health Policy, Elsevier, vol. 65(1), pages 5-19, July.
    17. Christian Biener & Martin Eling, 2011. "The Performance of Microinsurance Programs: A Data Envelopment Analysis," Journal of Risk & Insurance, The American Risk and Insurance Association, vol. 78(1), pages 83-115, March.
    18. Buntin, Melinda Beeuwkes & Zaslavsky, Alan M., 2004. "Too much ado about two-part models and transformation?: Comparing methods of modeling Medicare expenditures," Journal of Health Economics, Elsevier, vol. 23(3), pages 525-542, May.
    19. Zhang, Licheng & Wang, Hong, 2008. "Dynamic process of adverse selection: Evidence from a subsidized community-based health insurance in rural China," Social Science & Medicine, Elsevier, vol. 67(7), pages 1173-1182, October.
    20. Duggan, Mark, 2004. "Does contracting out increase the efficiency of government programs? Evidence from Medicaid HMOs," Journal of Public Economics, Elsevier, vol. 88(12), pages 2549-2572, December.
    21. Smith, Kimberly V. & Sulzbach, Sara, 2008. "Community-based health insurance and access to maternal health services: Evidence from three West African countries," Social Science & Medicine, Elsevier, vol. 66(12), pages 2460-2473, June.
    22. Jonathan Gruber & Maria Owings, 1996. "Physician Financial Incentives and Cesarean Section Delivery," RAND Journal of Economics, The RAND Corporation, vol. 27(1), pages 99-123, Spring.
    23. WHO & UNICEF & UNFPA & World Bank & United Nations Population Division, 2014. "Trends in Maternal Mortality : 1990 to 2013," World Bank Publications - Books, The World Bank Group, number 18203, December.
    24. Yi Yao & Joan T. Schmit & Justin R. Sydnor, 2017. "The Role Of Pregnancy In Micro Health Insurance: Evidence Of Adverse Selection From Pakistan," Journal of Risk & Insurance, The American Risk and Insurance Association, vol. 84(4), pages 1073-1102, December.
    25. Duan, Naihua, et al, 1983. "A Comparison of Alternative Models for the Demand for Medical Care," Journal of Business & Economic Statistics, American Statistical Association, vol. 1(2), pages 115-126, April.
    26. Yi (Kitty) Yao, 2013. "Development and Sustainability of Emerging Health Insurance Markets: Evidence from Microinsurance in Pakistan," The Geneva Papers on Risk and Insurance - Issues and Practice, Palgrave Macmillan;The Geneva Association, vol. 38(1), pages 160-180, January.
    27. Leibowitz, Arleen & Buchanan, Joan L. & Mann, Joyce, 1992. "A randomized trial to evaluate the effectiveness of a Medicaid HMO," Journal of Health Economics, Elsevier, vol. 11(3), pages 235-257, October.
    28. McQuestion, Michael J. & Velasquez, Anibal, 2006. "Evaluating program effects on institutional delivery in Peru," Health Policy, Elsevier, vol. 77(2), pages 221-232, July.
    29. Borislava Mihaylova & Andrew Briggs & Anthony O'Hagan & Simon G. Thompson, 2011. "Review of statistical methods for analysing healthcare resources and costs," Health Economics, John Wiley & Sons, Ltd., vol. 20(8), pages 897-916, August.
    30. Beck, Konstantin & Trottmann, Maria & Zweifel, Peter, 2010. "Risk adjustment in health insurance and its long-term effectiveness," Journal of Health Economics, Elsevier, vol. 29(4), pages 489-498, July.
    31. Manning, Willard G. & Mullahy, John, 2001. "Estimating log models: to transform or not to transform?," Journal of Health Economics, Elsevier, vol. 20(4), pages 461-494, July.
    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. Xiaoqi Zhang & Yi Chen & Yi Yao, 2021. "Dynamic information asymmetry in micro health insurance: implications for sustainability," The Geneva Papers on Risk and Insurance - Issues and Practice, Palgrave Macmillan;The Geneva Association, vol. 46(3), pages 468-507, July.

    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. Julie Shi & Yi Yao & Gordon Liu, 2018. "Modeling individual health care expenditures in China: Evidence to assist payment reform in public insurance," Health Economics, John Wiley & Sons, Ltd., vol. 27(12), pages 1945-1962, December.
    2. Galina Besstremyannaya, 2014. "Heterogeneous effect of coinsurance rate on healthcare costs: generalized finite mixtures and matching estimators," Discussion Papers 14-014, Stanford Institute for Economic Policy Research.
    3. Besstremyannaya, Galina, 2017. "Measuring income equity in the demand for healthcare with finite mixture models," Applied Econometrics, Russian Presidential Academy of National Economy and Public Administration (RANEPA), vol. 46, pages 5-29.
    4. Sungchul Park & Anirban Basu, 2018. "Alternative evaluation metrics for risk adjustment methods," Health Economics, John Wiley & Sons, Ltd., vol. 27(6), pages 984-1010, June.
    5. Galina Besstremyannaya, 2012. "Estimating income equity in social health insurance system," Working Papers w0172, New Economic School (NES).
    6. Xiaoqi Zhang & Yi Chen & Yi Yao, 2021. "Dynamic information asymmetry in micro health insurance: implications for sustainability," The Geneva Papers on Risk and Insurance - Issues and Practice, Palgrave Macmillan;The Geneva Association, vol. 46(3), pages 468-507, July.
    7. Randall P. Ellis & Pooja G. Mookim, 2013. "K-Fold Cross-Validation is Superior to Split Sample Validation for Risk Adjustment Models," Boston University - Department of Economics - Working Papers Series wp2013-026, Boston University - Department of Economics.
    8. Jones, A. & Lomas, J. & Rice, N., 2014. "Going Beyond the Mean in Healthcare Cost Regressions: a Comparison of Methods for Estimating the Full Conditional Distribution," Health, Econometrics and Data Group (HEDG) Working Papers 14/26, HEDG, c/o Department of Economics, University of York.
    9. Andrew M. Jones & James Lomas & Nigel Rice, 2015. "Healthcare Cost Regressions: Going Beyond the Mean to Estimate the Full Distribution," Health Economics, John Wiley & Sons, Ltd., vol. 24(9), pages 1192-1212, September.
    10. Timothy J. Layton & Randall P. Ellis & Thomas G. McGuire, 2015. "Assessing Incentives for Adverse Selection in Health Plan Payment Systems," Boston University - Department of Economics - Working Papers Series wp2015-024, Boston University - Department of Economics.
    11. Jones, A.M, 2010. "Models For Health Care," Health, Econometrics and Data Group (HEDG) Working Papers 10/01, HEDG, c/o Department of Economics, University of York.
    12. Toni Mora & Joan Gil & Antoni Sicras-Mainar, 2012. "The Influence of BMI, Obesity and Overweight on Medical Costs: A Panel Data Approach," Working Papers 2012-08, FEDEA.
    13. Toni Mora & Joan Gil & Antoni Sicras-Mainar, 2015. "The influence of obesity and overweight on medical costs: a panel data perspective," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 16(2), pages 161-173, March.
    14. Jay Dev Dubey, 2021. "Measuring Income Elasticity of Healthcare-Seeking Behavior in India: A Conditional Quantile Regression Approach," Journal of Quantitative Economics, Springer;The Indian Econometric Society (TIES), vol. 19(4), pages 767-793, December.
    15. Kurt Lavetti & Thomas DeLeire & Nicolas R. Ziebarth, 2023. "How do low‐income enrollees in the Affordable Care Act marketplaces respond to cost‐sharing?," Journal of Risk & Insurance, The American Risk and Insurance Association, vol. 90(1), pages 155-183, March.
    16. Frank, Richard G. & Glazer, Jacob & McGuire, Thomas G., 2000. "Measuring adverse selection in managed health care," Journal of Health Economics, Elsevier, vol. 19(6), pages 829-854, November.
    17. Hao Yu, 2017. "China’s medical savings accounts: an analysis of the price elasticity of demand for health care," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 18(6), pages 773-785, July.
    18. Glazer, Jacob & McGuire, Thomas G., 2002. "Setting health plan premiums to ensure efficient quality in health care: minimum variance optimal risk adjustment," Journal of Public Economics, Elsevier, vol. 84(2), pages 153-173, May.
    19. Andreas Bayerstadler & Franz Benstetter & Christian Heumann & Fabian Winter, 2014. "A predictive modeling approach to increasing the economic effectiveness of disease management programs," Health Care Management Science, Springer, vol. 17(3), pages 284-301, September.
    20. Brilleman, Samuel L. & Gravelle, Hugh & Hollinghurst, Sandra & Purdy, Sarah & Salisbury, Chris & Windmeijer, Frank, 2014. "Keep it simple? Predicting primary health care costs with clinical morbidity measures," Journal of Health Economics, Elsevier, vol. 35(C), pages 109-122.

    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:pal:gpprii:v:44:y:2019:i:3:d:10.1057_s41288-018-00115-5. 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: Sonal Shukla or Springer Nature Abstracting and Indexing (email available below). General contact details of provider: http://www.palgrave-journals.com/ .

    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.