Estimating Willingness-to-Pay for health insurance among rural poor in India by reference to Engel's law
Community-Based Health Insurance (CBHI) (a.k.a. micro health insurance) is a contributory health insurance among rural poor in developing countries. As CBHI schemes typically function with no subsidy income, the schemes' expenditures cannot exceed their premium income. A good estimate of Willingness-To-Pay (WTP) among the target population affiliating on a voluntary basis is therefore essential for package design. Previous estimates of WTP reported materially and significantly different WTP levels across locations (even within one state), making it necessity to base estimates on household surveys. This is time-consuming and expensive. This study seeks to identify a coherent anchor for local estimation of WTP without having to rely on household surveys in each CBHI implementation. Using data collected in 2008–2010 among rural poor households in six locations in India (total 7874 households), we found that in all locations WTP expressed as percentage of income decreases with household income. This reminds of Engel's law on food expenditures. We checked several possible anchors: overall income, discretionary income and food expenditures. We compared WTP expressed as percentage of these anchors, by calculating the Coefficient of Variation (for inter-community variation) and Concentration indices (for intra-community variation). The Coefficient of variation was 0.36, 0.43 and 0.50 for WTP as percent of food expenditures, overall income and discretionary income, respectively. In all locations the concentration index for WTP as percentage of food expenditures was the lowest. Thus, food expenditures had the most consistent relationship with WTP within each location and across the six locations. These findings indicate that like food, health insurance is considered a necessity good even by people with very low income and no prior experience with health insurance. We conclude that the level of WTP could be estimated based on each community's food expenditures, and that this information can be obtained everywhere without having to conduct household surveys.
Volume (Year): 76 (2013)
Issue (Month): C ()
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- Dong, Hengjin & Kouyate, Bocar & Cairns, John & Sauerborn, Rainer, 2005. "Inequality in willingness-to-pay for community-based health insurance," Health Policy, Elsevier, vol. 72(2), pages 149-156, May.
- Berman, Peter A., 1998. "Rethinking health care systems: Private health care provision in India," World Development, Elsevier, vol. 26(8), pages 1463-1479, August.
- 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.
- Rajeev Ahuja, 2005. "Health Insurance for the poor in India: An analytical study," Indian Council for Research on International Economic Relations, New Delhi Working Papers 161, Indian Council for Research on International Economic Relations, New Delhi, India.
- Gabriela Flores & Jaya Krishnakumar & Owen O'Donnell & Eddy van Doorslaer, 2008. "Coping with health-care costs: implications for the measurement of catastrophic expenditures and poverty," Health Economics, John Wiley & Sons, Ltd., vol. 17(12), pages 1393-1412.
- Asenso-Okyere, W. Kwadwo & Osei-Akoto, Isaac & Anum, Adote & Appiah, Ernest N., 1997. "Willingness to pay for health insurance in a developing economy. A pilot study of the informal sector of Ghana using contingent valuation," Health Policy, Elsevier, vol. 42(3), pages 223-237, December.
- Gustafsson-Wright, Emily & Asfaw, Abay & van der Gaag, Jacques, 2009. "Willingness to pay for health insurance: An analysis of the potential market for new low-cost health insurance products in Namibia," Social Science & Medicine, Elsevier, vol. 69(9), pages 1351-1359, November.
- Xiao-Hua Ying & Teh-Wei Hu & Jane Ren & Wen Chen & Ke Xu & Jin-Hui Huang, 2007. "Demand for private health insurance in Chinese urban areas," Health Economics, John Wiley & Sons, Ltd., vol. 16(10), pages 1041-1050.
- Pratap, Sangeeta & Quintin, Erwan, 2006. "The Informal Sector in Developing Countries: Output, Assets and Employment," Working Paper Series RP2006/130, World Institute for Development Economic Research (UNU-WIDER).
- Dong, Hengjin & Kouyate, Bocar & Snow, Rachel & Mugisha, Frederick & Sauerborn, Rainer, 2003. "Gender's effect on willingness-to-pay for community-based insurance in Burkina Faso," Health Policy, Elsevier, vol. 64(2), pages 153-162, May.
- Wagstaff, Adam, 2008. "Measuring financial protection in health," Policy Research Working Paper Series 4554, The World Bank.
- Hengjin Dong & Bocar Kouyate & John Cairns & Frederick Mugisha & Rainer Sauerborn, 2003. "Willingness-to-pay for community-based insurance in Burkina Faso," Health Economics, John Wiley & Sons, Ltd., vol. 12(10), pages 849-862.
- David H. Peters & Abdo S. Yazbeck & Rashmi R. Sharma & G. N. V. Ramana & Lant H. Pritchett & Adam Wagstaff, 2002. "Better Health Systems for India's Poor : Findings, Analysis, and Options," World Bank Publications, The World Bank, number 14080.
- Asfaw, Abay & Braun, Joachim von, 2004. "Can community health insurance schemes shield the poor against the downside health effects of economic reforms? The case of rural ethiopia," Health Policy, Elsevier, vol. 70(1), pages 97-108, October.
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