IDEAS home Printed from https://ideas.repec.org/
MyIDEAS: Login to save this article or follow this journal

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

  • Jehu-Appiah, Caroline
  • Aryeetey, Genevieve
  • Spaan, Ernst
  • Agyepong, Irene
  • Baltussen, Rob
Registered author(s):

    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.

    If you experience problems downloading a file, check if you have the proper application to view it first. In case of further problems read the IDEAS help page. Note that these files are not on the IDEAS site. Please be patient as the files may be large.

    File URL: http://www.sciencedirect.com/science/article/B6V8X-4Y0C27V-2/2/0e9c063b0f1d0339f1b69ad134f1ec58
    Download Restriction: Full text for ScienceDirect subscribers only

    As the access to this document is restricted, you may want to look for a different version under "Related research" (further below) or search for a different version of it.

    Article provided by Elsevier in its journal Health Policy.

    Volume (Year): 95 (2010)
    Issue (Month): 2-3 (May)
    Pages: 166-173

    as
    in new window

    Handle: RePEc:eee:hepoli:v:95:y:2010:i:2-3:p:166-173
    Contact details of provider: Web page: http://www.elsevier.com/locate/healthpol

    References listed on IDEAS
    Please report citation or reference errors to , or , if you are the registered author of the cited work, log in to your RePEc Author Service profile, click on "citations" and make appropriate adjustments.:

    as in new window
    1. Reyes, Celia M., 2006. "Alternative Means Testing Options Using CBMS," Discussion Papers DP 2006-22, Philippine Institute for Development Studies.
    2. François Bourguignon & Satya Chakravarty, 2003. "The Measurement of Multidimensional Poverty," Journal of Economic Inequality, Springer, vol. 1(1), pages 25-49, April.
    3. Julia Johannsen, 2006. "Operational Poverty Targeting In Peru ? Proxy Means Testing With Non-Income Indicators," Working Papers 30, International Policy Centre for Inclusive Growth.
    4. Ravallion, Martin, 1994. "Measuring Social Welfare with and without Poverty Lines," American Economic Review, American Economic Association, vol. 84(2), pages 359-64, May.
    5. Caroline Dewilde, 2004. "The Multidimensional Measurement of Poverty in Belgium and Britain: A Categorical Approach," Social Indicators Research, Springer, vol. 68(3), pages 331-369, September.
    6. Bigman, David, et al, 2000. "Community Targeting for Poverty Reduction in Burkina Faso," World Bank Economic Review, World Bank Group, vol. 14(1), pages 167-93, January.
    7. 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 761-92, July.
    8. 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), December.
    9. 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 32756, The World Bank.
    10. Ravallion, M., 1992. "Poverty Comparisons - A Guide to Concepts and Methods," Papers 88, World Bank - Living Standards Measurement.
    11. 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.
    12. 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.
    13. 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.
    14. Mark Montgomery & Paul Hewett, 2005. "Urban poverty and health in developing countries: Household and neighborhood Effects," Demography, Springer, vol. 42(3), pages 397-425, August.
    15. Elbers, Chris & Tomoki Fujii & Lanjouw, Peter & Ozler, Berk & Yin, Wesley, 2004. "Poverty alleviation through geographic targeting : how much does disaggregation help?," Policy Research Working Paper Series 3419, The World Bank.
    16. 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.
    17. Ravallion, Martin, 1996. "Issues in measuring and modeling poverty," Policy Research Working Paper Series 1615, The World Bank.
    18. 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.
    19. Sharif, Iffath A., 2009. "Building a targeting system for Bangladesh based on proxy means testing," Social Protection Discussion Papers 50670, The World Bank.
    20. Minot, Nicholas, 2000. "Generating Disaggregated Poverty Maps: An Application to Vietnam," World Development, Elsevier, vol. 28(2), pages 319-331, February.
    21. 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.
    22. 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.
    23. Celia M. Reyes, 2006. "Alternative Means Testing Options Using CBMS," Development Economics Working Papers 22685, East Asian Bureau of Economic Research.
    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. Grosh, M.E. & Baker, J.L., 1995. "Proxy Means Tests for Targetting Social Programs. Simulations and Speculation," Papers 118, World Bank - Living Standards Measurement.
    26. Hentschel, Jesko, et al, 2000. "Combining Census and Survey Data to Trace the Spatial Dimensions of Poverty: A Case Study of Ecuador," World Bank Economic Review, World Bank Group, vol. 14(1), pages 147-65, January.
    Full references (including those not matched with items on IDEAS)

    This item is not listed on Wikipedia, on a reading list or among the top items on IDEAS.

    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.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (Zhang, Lei)

    or ()

    The email address of this maintainer does not seem to be valid anymore. Please ask to update the entry or send us the correct address

    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 references are entirely missing, you can add them using this form.

    If the full references list an item that is present in RePEc, but the system did not link 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 profile, as there may be some citations waiting for confirmation.

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

    This information is provided to you by IDEAS at the Research Division of the Federal Reserve Bank of St. Louis using RePEc data.