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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

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.

Suggested Citation

  • Dror, David Mark & Koren, Ruth & Ost, Alexander & Binnendijk, Erika & Vellakkal, Sukumar & Danis, Marion, 2007. "Health insurance benefit packages prioritized by low-income clients in India: Three criteria to estimate effectiveness of choice," Social Science & Medicine, Elsevier, vol. 64(4), pages 884-896, February.
  • Handle: RePEc:eee:socmed:v:64:y:2007:i:4:p:884-896
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    References listed on IDEAS

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    1. Doris Wiesmann & Johannes J├╝tting, 2000. "The emerging movement of community based health insurance in sub-Saharan Africa: Experiences and lessons learned," Africa Spectrum, Institute of African Affairs, GIGA German Institute of Global and Area Studies, Hamburg, vol. 35(2), pages 193-210.
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    3. De Allegri, Manuela & Sanon, Mamadou & Bridges, John & Sauerborn, Rainer, 2006. "Understanding consumers' preferences and decision to enrol in community-based health insurance in rural West Africa," Health Policy, Elsevier, vol. 76(1), pages 58-71, March.
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    5. Dong, Hengjin & Mugisha, Frederick & Gbangou, Adjima & Kouyate, Bocar & Sauerborn, Rainer, 2004. "The feasibility of community-based health insurance in Burkina Faso," Health Policy, Elsevier, vol. 69(1), pages 45-53, July.
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    Cited by:

    1. 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.
    2. Syed M. Ahsan & Shubhasish Barua & Jaimie Tax, 2010. "Toward an Efficient and Sustainable Microinsurance Market: The Regulatory Perspective," Working Papers 2, Institute of Microfinance (InM).
    3. 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.
    4. Abiiro, Gilbert Abotisem & Torbica, Aleksandra & Kwalamasa, Kassim & De Allegri, Manuela, 2014. "Eliciting community preferences for complementary micro health insurance: A discrete choice experiment in rural Malawi," Social Science & Medicine, Elsevier, vol. 120(C), pages 160-168.
    5. Victoor, Aafke & Hansen, Johan & van den Akker-van Marle, M. Elske & van den Berg, Bernard & van den Hout, Wilbert B. & de Jong, Judith D., 2014. "Choosing your health insurance package: A method for measuring the public's preferences for changes in the national health insurance plan," Health Policy, Elsevier, vol. 117(2), pages 257-265.
    6. Victoria Fan & Anup Karan & Ajay Mahal, 2012. "State health insurance and out-of-pocket health expenditures in Andhra Pradesh, India," International Journal of Health Economics and Management, Springer, vol. 12(3), pages 189-215, September.
    7. 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.
    8. Rama Pal, 2012. "Measuring incidence of catastrophic out-of-pocket health expenditure: with application to India," International Journal of Health Economics and Management, Springer, vol. 12(1), pages 63-85, March.
    9. repec:eee:socmed:v:196:y:2018:i:c:p:131-141 is not listed on IDEAS
    10. 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.

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