Abstract
BackgroundMost healthcare spending in developing countries is private out-of-pocket. One explanation for low penetration of health insurance is that poorer individuals doubt their ability to enforce insurance contracts. Community-based health insurance schemes (CBHI) are a solution, but launching CBHI requires obtaining accurate local data on morbidity, healthcare utilization and other details to inform package design and pricing. We developed the “Illness Mapping” method (IM) for data collection (faster and cheaper than household surveys).MethodsIM is a modification of two non-interactive consensus group methods (Delphi and Nominal Group Technique) to operate as interactive methods. We elicited estimates from “Experts” in the target community on morbidity and healthcare utilization. Interaction between facilitator and experts became essential to bridge literacy constraints and to reach consensus.The study was conducted in Gaya District, Bihar (India) during April-June 2010. The intervention included the IM and a household survey (HHS). IM included 18 women’s and 17 men’s groups. The HHS was conducted in 50 villages with1,000 randomly selected households (6,656 individuals).ResultsWe found good agreement between the two methods on overall prevalence of illness (IM: 25.9% ±3.6; HHS: 31.4%) and on prevalence of acute (IM: 76.9%; HHS: 69.2%) and chronic illnesses (IM: 20.1%; HHS: 16.6%). We also found good agreement on incidence of deliveries (IM: 3.9% ±0.4; HHS: 3.9%), and on hospital deliveries (IM: 61.0%. ± 5.4; HHS: 51.4%). For hospitalizations, we obtained a lower estimate from the IM (1.1%) than from the HHS (2.6%). The IM required less time and less person-power than a household survey, which translate into reduced costs.ConclusionsWe have shown that our Illness Mapping method can be carried out at lower financial and human cost for sourcing essential local data, at acceptably accurate levels. In view of the good fit of results obtained, we assume that the method could work elsewhere as well.
Highlights
Most healthcare spending in developing countries is private out-of-pocket
The effort to introduce health insurance among low income persons in areas in the informal economy requires that the benefit packages as well as the premiums payable will be customized to local conditions
We have explored the Illness Mapping method on the assumption that it can deliver a cheaper and faster resourcing of the essential local data, at acceptably accurate levels
Summary
Most healthcare spending in developing countries is private out-of-pocket. Community-based health insurance schemes (CBHI) are a solution, but launching CBHI requires obtaining accurate local data on morbidity, healthcare utilization and other details to inform package design and pricing. A large part of health care spending in developing countries is private and out of pocket (OOP). One of the hurdles to launching CBHI schemes is obtaining relevant information on local morbidity, healthcare utilization and other information that would inform the design and pricing of a relevant and affordable insurance package. A number of experiments with micro health insurance have relied on household surveys to obtain reliable local actuarial estimates and other information required for package design and pricing [14,15,16]. A faster and cheaper method would be instrumental in promoting the expansion of micro health insurance
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