The Demand for (Micro) Health Insurance in the Informal Sector

Dror, David M.; Firth, Lucy

doi:10.1057/gpp.2014.24

Cited by 32 publications

(44 citation statements)

References 59 publications

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“…From a theory perspective, our results suggest that the role of the insured population in selecting package design and pricing, and their ability to favour benefits that were likely to reduce hardship financing uphold the arguments of Dror and Firth29 about demand. From an ethical perspective, the use of CRCT in our experiment implied withholding access of some people to benefits, and thus may not be the most suited research design.…”

Section: Discussionsupporting

confidence: 50%

Impact of community-based health insurance in rural India on self-medication & financial protection of the insured

Dror¹,

Chakraborty²,

Majumdar³

et al. 2016

Indian J Med Res

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Background & objectives:The evidence-base of the impact of community-based health insurance (CBHI) on access to healthcare and financial protection in India is weak. We investigated the impact of CBHI in rural Uttar Pradesh and Bihar States of India on insured households’ self-medication and financial position.Methods:Data originated from (i) household surveys, and (ii) the Management Information System of each CBHI. Study design was “staggered implementation” cluster randomized controlled trial with enrollment of one-third of the treatment group in each of the years 2011, 2012 and 2013. Around 40-50 per cent of the households that were offered to enroll joined. The benefits-packages covered outpatient care in all three locations and in-patient care in two locations. To overcome self-selection enrollment bias, we constructed comparable control and treatment groups using Kernel Propensity Score Matching (K-PSM). To quantify impact, both difference-in-difference (DiD), and conditional-DiD (combined K-PSM with DiD) were used to assess robustness of results.Results:Post-intervention (2013), self-medication was less practiced by insured HHs. Fewer insured households than uninsured households reported borrowing to finance care for non-hospitalization events. Being insured for two years also improved the HH's location along the income distribution, namely insured HHs were more likely to experience income quintile-upgrade in one location, and less likely to experience a quintile-downgrade in two locations.Interpretation & conclusions:The realized benefits of insurance included better access to healthcare, reduced financial risks and improved economic mobility, suggesting that in our context health insurance creates welfare gains. These findings have implications for theoretical, ethical, policy and practice considerations.

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Section: Discussionsupporting

confidence: 50%

Impact of community-based health insurance in rural India on self-medication & financial protection of the insured

Dror¹,

Chakraborty²,

Majumdar³

et al. 2016

Indian J Med Res

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“…In recent years, micro–health insurance (MHI) initiatives have been widely implemented across low‐ and middle‐income countries as a means of extending social health protection to people working in the informal sector . The concept of MHI refers to a form of voluntary health insurance that targets low‐income people who are normally not included in existing health protection systems . Available evidence indicates that MHI schemes can improve access to care and reduce out‐of‐pocket expenditure among their members .…”

Section: Introductionmentioning

confidence: 99%

“…In an attempt to understand low uptake of MHI among target communities, attention has mostly been paid to assessing determinants of enrolment. Specifically, researchers have explored how both a household sociodemographic and economic profile and the features of a scheme (design, benefit package, and management structures) influence the decision of whether or not to join an MHI scheme . However, very little research has looked at perceptions and reactions to scheme implementation processes among target communities.…”

Section: Introductionmentioning

confidence: 99%

Implementation of the redesigned Community Health Fund in the Dodoma region of Tanzania: A qualitative study of views from rural communities

Kalolo

Gautier

Radermacher³

et al. 2017

Health Planning & Management

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The need to understand how an intervention is received by the beneficiary community is well recognised and particularly neglected in the micro-health insurance (MHI) domain. This study explored the views and reactions of the beneficiary community of the redesigned Community Health Fund (CHF) implemented in the Dodoma region of Tanzania. We collected data from focus group discussions with 24 groups of villagers (CHF members and nonmembers) and in-depth interviews with 12 key informants (enrolment officers and health care workers). The transcribed material was analysed thematically. We found that participants highly appreciate the scheme, but to be resolved are the challenges posed by the implementation strategies adopted. The responses of the community were nested within a complex pathway relating to their interaction with the implementation strategies and their ongoing reflections regarding the benefits of the scheme. Community reactions ranged from accepting to rejecting the scheme, demanding the right to receive benefit packages once enrolled, and dropping out of the scheme when it failed to meet their expectations. Reported drivers of the responses included intensity of CHF communication activities, management of enrolment procedures, delivery of benefit packages, critical features of the scheme, and contextual factors (health system and socio-political context). This study highlights that scheme design and implementation strategies that address people's needs, voices, and values can improve uptake of MHI interventions. The study adds to the knowledge base on implementing MHI initiatives and could promote interests in assessing the response to interventions within the MHI domain and beyond.

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“…insurance can equalize an unequal distribution of wealth, under the a priori assumption of a diminishing marginal utility of wealth. Dror and Firth () challenged the classical EU theory by claiming that in the settings of poverty and informality, there may be dormant demand (reflecting needs) that does not necessarily and always generate solvent demand (reflecting willingness and ability to pay). Conversion of dormant to solvent demand follows economic decisions that are taken by groups of closely related persons rather than individually.…”

Section: Lessons Learned During Twenty Years Of Implementing Microinsmentioning

confidence: 99%

Microinsurance: A short history

Dror

2019

Int Social Security Review

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Twenty years ago, the International Social Security Review published an article that introduced a new term to the vocabulary of development and social protection: Microinsurance. Now, twenty years later, it is suitable to take stock of the contribution of microinsurance towards promoting coverage and social security. The article reviews the main insights gained from 20 years of implementation, including a clear expression of the value proposition of health microinsurance, understanding the demand for microinsurance, the business process for successful implementation, and conditions that must be satisfied for scaling and sustainable operations. It also explains the context that led to a considerable divergence in the microinsurance space. The article offers a discussion of unresolved issues and thoughts about the future of microinsurance. The conclusion of this article is that microinsurance can flourish when the necessary four pillars for its implementation exist, namely mainstreaming through political support, enhanced insurance literacy of the customers, technical assistance to self‐administer the schemes, and availability of seed capital. The sufficient additional condition is that customers perceive microinsurance as offering welfare gains that cannot be obtained by other means.

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The Demand for (Micro) Health Insurance in the Informal Sector

Cited by 32 publications

References 59 publications

Impact of community-based health insurance in rural India on self-medication & financial protection of the insured

Impact of community-based health insurance in rural India on self-medication & financial protection of the insured

Implementation of the redesigned Community Health Fund in the Dodoma region of Tanzania: A qualitative study of views from rural communities

Microinsurance: A short history

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