IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v64y2007i4p884-896.html
   My bibliography  Save this article

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

Author

Listed:
  • 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
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0277-9536(06)00548-X
    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 below or search for a different version of it.

    Other versions of this item:

    References listed on IDEAS

    as
    1. Dror, David Mark & Radermacher, Ralf & Koren, Ruth, 2007. "Willingness to pay for health insurance among rural and poor persons: Field evidence from seven micro health insurance units in India," Health Policy, Elsevier, vol. 82(1), pages 12-27, June.
    2. 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.
    3. Rajeev Ahuja & Johannes Jutting, 2004. "Are the poor too poor to demand health insurance?," Indian Council for Research on International Economic Relations, New Delhi Working Papers 118, Indian Council for Research on International Economic Relations, New Delhi, India.
    4. Joanna Coast, 2001. "Citizens, their agents and health care rationing: an exploratory study using qualitative methods," Health Economics, John Wiley & Sons, Ltd., vol. 10(2), pages 159-174, March.
    5. Doris Wiesmann & Johannes Jütting, 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.
    6. Tabor, Steven R., 2005. "Community-based health insurance and social protection policy," Social Protection Discussion Papers and Notes 32545, The World Bank.
    7. 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.
    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. 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. David Mark Dror, 2018. "Enrollment in Community-based Health Insurance Schemes in Rural Bihar and Uttar Pradesh, India," World Scientific Book Chapters, in: Financing Micro Health Insurance Theory, Methods and Evidence, chapter 17, pages 345-363, World Scientific Publishing Co. Pte. Ltd..
    4. 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.
    5. 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.
    6. 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.
    7. Mohd Zuhair & Ram Babu Roy, 2022. "Eliciting relative preferences for the attributes of health insurance schemes among rural consumers in India," International Journal of Health Economics and Management, Springer, vol. 22(4), pages 443-458, December.
    8. 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.
    9. 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.
    10. 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.
    11. Sayem Ahmed & Mohammad Enamul Hoque & Abdur Razzaque Sarker & Marufa Sultana & Ziaul Islam & Rukhsana Gazi & Jahangir A M Khan, 2016. "Willingness-to-Pay for Community-Based Health Insurance among Informal Workers in Urban Bangladesh," PLOS ONE, Public Library of Science, vol. 11(2), pages 1-16, February.
    12. Chatterjee, Chirantan & Joshi, Radhika & Sood, Neeraj & Boregowda, P., 2018. "Government health insurance and spatial peer effects: New evidence from India," Social Science & Medicine, Elsevier, vol. 196(C), pages 131-141.

    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. Hermann Donfouet & Pierre-Alexandre Mahieu & Eric Malin, 2013. "Using respondents’ uncertainty scores to mitigate hypothetical bias in community-based health insurance studies," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 14(2), pages 277-285, April.
    2. David Mark Dror, 2018. "What Factors Affect Voluntary Uptake of Community-based Health Insurance Schemes in Lowand Middle-Income Countries? A Systematic Review and Meta-Analysis," World Scientific Book Chapters, in: Financing Micro Health Insurance Theory, Methods and Evidence, chapter 14, pages 271-306, World Scientific Publishing Co. Pte. Ltd..
    3. Macha, Raphael Rasiel, 2015. "Community Based Health Insurance Schemes and Protection of the Rural Poor: Empirical evidence from Tanzania," African Journal of Economic Review, African Journal of Economic Review, vol. 3(2), July.
    4. Hermann Donfouet & Pierre-Alexandre Mahieu, 2012. "Community-based health insurance and social capital: a review," Health Economics Review, Springer, vol. 2(1), pages 1-5, December.
    5. Mohd Zuhair & Ram Babu Roy, 2022. "Eliciting relative preferences for the attributes of health insurance schemes among rural consumers in India," International Journal of Health Economics and Management, Springer, vol. 22(4), pages 443-458, December.
    6. Mohd Zuhair & Fuli Zhou & Saurabh Pratap & Ram Babu Roy, 2022. "Eliciting key attributes of health insurance in rural India: a qualitative analysis," SN Business & Economics, Springer, vol. 2(3), pages 1-28, March.
    7. 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.
    8. Gnawali, Devendra Prasad & Pokhrel, Subhash & Sié, Ali & Sanon, Mamadou & De Allegri, Manuela & Souares, Aurélia & Dong, Hengjin & Sauerborn, Rainer, 2009. "The effect of community-based health insurance on the utilization of modern health care services: Evidence from Burkina Faso," Health Policy, Elsevier, vol. 90(2-3), pages 214-222, May.
    9. Nikièma, Béatrice & Haddad, Slim & Potvin, Louise, 2008. "Women Bargaining to Seek Healthcare: Norms, Domestic Practices, and Implications in Rural Burkina Faso," World Development, Elsevier, vol. 36(4), pages 608-624, April.
    10. Mebratie, Anagaw D. & Sparrow, Robert & Yilma, Zelalem & Abebaw, Degnet & Alemu, Getnet & Bedi, Arjun S., 2019. "The impact of Ethiopia's pilot community based health insurance scheme on healthcare utilization and cost of care," Social Science & Medicine, Elsevier, vol. 220(C), pages 112-119.
    11. Sukumar Vellakkal, 2013. "Determinants of Enrolment in Voluntary Health Insurance: Evidences from a Mixed Method Study, Kerala, India," International Journal of Financial Research, International Journal of Financial Research, Sciedu Press, vol. 4(2), pages 99-107, April.
    12. Hermann Donfouet & P. Jeanty & P.-A. Mahieu, 2014. "Dealing with internal inconsistency in double-bounded dichotomous choice: an application to community-based health insurance," Empirical Economics, Springer, vol. 46(1), pages 317-328, February.
    13. Fink, Günther & Robyn, Paul Jacob & Sié, Ali & Sauerborn, Rainer, 2013. "Does health insurance improve health?," Journal of Health Economics, Elsevier, vol. 32(6), pages 1043-1056.
    14. 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.
    15. Paul McNamee & Laura Ternent & Adjima Gbangou & David Newlands, 2010. "A game of two halves? Incentive incompatibility, starting point bias and the bidding game contingent valuation method," Health Economics, John Wiley & Sons, Ltd., vol. 19(1), pages 75-87, January.
    16. Tin Su & Steffen Flessa, 2013. "Determinants of household direct and indirect costs: an insight for health-seeking behaviour in Burkina Faso," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 14(1), pages 75-84, February.
    17. Donfouet, Hermann Pythagore Pierre & Mohamed, Shukri F. & Otieno, Peter & Wambiya, Elvis & Mutua, Martin Kavao & Danaei, Goodarz, 2020. "Economic valuation of setting up a social health enterprise in urban poor-resource setting in Kenya," Social Science & Medicine, Elsevier, vol. 266(C).
    18. Dosse Mawussi Djahini-Afawoubo & Esso-Hanam Atake, 2018. "Extension of mandatory health insurance to informal sector workers in Togo," Health Economics Review, Springer, vol. 8(1), pages 1-13, December.
    19. Mebratie, A.D. & Sparrow, R.A. & Alemu, G. & Bedi, A.S., 2013. "Community-Based Health Insurance Schemes," ISS Working Papers - General Series 568, International Institute of Social Studies of Erasmus University Rotterdam (ISS), The Hague.
    20. Mebratie, Anagaw D. & Sparrow, Robert & Yilma, Zelalem & Alemu, Getnet & Bedi, Arjun S., 2015. "Enrollment in Ethiopia’s Community-Based Health Insurance Scheme," World Development, Elsevier, vol. 74(C), pages 58-76.

    More about this item

    Keywords

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

    JEL classification:

    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private
    • I15 - Health, Education, and Welfare - - Health - - - Health and Economic Development

    Statistics

    Access and download statistics

    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:socmed:v:64:y:2007:i:4:p:884-896. 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 (email available below). General contact details of provider: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description .

    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.