Micro Health Insurance Research Articles

Value for solidarity: a proxy for community understanding and acceptance of the basic principles of community-based health insurance in rural Ethiopia

BackgroundSolidarity is an aspect of human association that gives emphasis to the cohesive social bond that holds a group together and is valued and understood by all members of the group. A lack of understanding of the solidarity principle is one of the main reasons for low population coverage in microhealth insurance schemes. This study aimed to examine the extent to which people value solidarity and the factors that explain the differences.MethodsA community-based cross-sectional study was carried out in two districts of northeast Ethiopia among 1232 randomly selected households which have ever been registered in a community-based health insurance scheme. Face-to-face interviews were conducted with household heads using a standardized questionnaire deployed to an electronic data collection platform. Solidarity was measured using three dimensions: income solidarity, risk solidarity, and cost coverage. Principal component analysis was used to construct composite variables, and the reliability of the tools was checked using Cronbach’s alpha. A multivariable analysis was performed using the partial proportional odds model to determine the associations between variables. The degree of association was assessed using the odds ratio, and statistical significance was determined at 95% confidence interval.ResultsThree-quarters (75%) of the respondents rated risk solidarity as high, while 70% and 63% rated income solidarity and cost coverage as high, respectively. Place of residence (AOR = 2.23; 95% CI: 1.68, 2.94), wealth index (AOR = 1.51; 95% CI: 1.07, 2.12), self-rated health status (AOR = 1.64; 95% CI: 1.12, 2.40), trust in insurance schemes (AOR = 1.68; 95% CI: 1.22, 2.30), perceived quality of care (AOR = 1.75; 95% CI: 1.33, 2.31) and frequency of outpatient visits (AOR = 2.05; 95% CI: 1.30, 3.24) were significant predictors of value for solidarity.ConclusionsThe community placed greater value for solidarity, indicating community understanding and acceptance of the core principles of microhealth insurance. Administrators of the insurance scheme, health authorities, and other actors should strive to create a transparent management system and improve access to high-quality health care, which will facilitate community acceptance of the insurance scheme and its guiding principles.

PERFORMANCE OF MUTUAL FUNDS ON SUSTAINABLE MICRO-HEALTH INSURANCE SCHEMES IN GHANA: The Role of Fast Adaptive Neural Network Classifier

Micro-health insurance models have emerged (in different forms) as a more reliable source of seeking financial protection for a significant proportion of Ghanaians against the downside of medical cost. Most micro-health insurance contributions end up with mutual funds hence the performance of the mutual fund determines to a large extent the sustainability of the scheme. This makes the mutual fund market an indispensable factor in stimulating or stifling healthcare access in Ghana with health equity implications. Recently, machine learning performance evaluation approaches such as Artificial Neural Networks (ANN) have proven valuable in evaluating the performance of mutual funds due to superior forecasting and calculating abilities relative to native algorithms. We applied a novel Fast Adaptive Neural Network Classifier (FANNC) to publicly available historical financial performance data from the Ghana Stock Exchange. We benchmarked our results against the outcome of a backpropagation neural network model (BPN) and measured speed of processing performance information for micro-health insurance managers looking for high earning but less risky investment destination for their vulnerable funds. The FANNC tool proved superior in terms of prediction error and processing time to existing robust models such as the Backpropagation neural network. Employing effective tools such as FANNC tools can quicken the pace of investment performance assessment, rank a hierarchy of desirable investment options for micro-health insurance schemes to explore. This can guarantee fast processing time and accurate investment decision of micro-health insurance to enable it play the essential role of enhancing health risk management of the members of the general public especially the poor and vulnerable that are often the victims of catastrophic healthcare expenditure.

Micro Health Insurance Among Rural Women

The study determined the level of awareness and satisfaction with micro health insurance among rural women in the Puducherry Union territory. Using survey methods, primary data was acquired from insured members via a questionnaire. With the help of SPSS 20.0, a Chi-Square analysis was performed to determine the level of awareness and satisfaction, as well as demographic and socioeconomic characteristics. The findings imply that boosting knowledge is a key prerequisite for voluntary participation in MHI schemes, and that interactive, contextualised awareness tools might help people better understand insurance. The research indicates that the Puducherry Union Territory's microhealth insurance scheme can be an effective instrument for increasing health among rural women.

Exploring the role of social representations in micro-health insurance scheme enrolment and retainment in sub-Saharan Africa: a scoping review.

Low enrolment in micro-health insurance (MHI) schemes is a recurring issue affecting the viability of such schemes. Beyond the efforts addressing low subscription and retention in these schemes, little is known on how social representations are related to micro-health insurance schemes enrolment and retention. This scoping review aimed at exploring the role of social representations in shaping enrollment and retention in MHI in sub-Saharan Africa. We reviewed qualitative, quantitative and mixed methods studies conducted between 2004 and 2019 in sub-Saharan Africa. We limited our search to peer-reviewed and grey literature in English and French reporting on social representations of MHI. We defined social representations as conventions, cultural and religious beliefs, local rules and norms, local solidarity practices, political landscape and social cohesion. We applied the framework developed by Arksey and O'Malley and modified by Levac etal. to identify and extract data from relevant studies. We extracted information from a total of 78 studies written in English (60%) and in French (40%) of which 56% were conducted in West Africa. More than half of all studies explored either cultural and religious beliefs (56%) or social conventions (55%) whereas only 37% focused on social cohesion (37%). Only six papers (8%) touched upon all six categories of social representation considered in this study whereas 25% of the papers studied more than three categories. We found that all the studied social representations influence enrollment and retention in MHI schemes. Our findings highlight the paucity of evidence on social representations in relation to MHI schemes. This initial attempt to compile evidence on social representations invites more research on the role those social representations play on the viability of MHI schemes. Our findings call for program design and implementation strategies to consider and adjust to local social representations in order to enhance scheme attractiveness.

Effectiveness of health voucher scheme and micro-health insurance scheme to support the poor and extreme poor in selected urban areas of Bangladesh: An assessment using a mixed-method approach.

National healthcare financing strategy recommends tax-based equity funds and insurance schemes for the poor and extreme poor living in urban slums and pavements as the majority of these population utilise informal providers resulting in adverse health effects and financial hardship. We assessed the effect of a health voucher scheme (HVS) and micro-health insurance (MHI) scheme on healthcare utilisation and out-of-pocket (OOP) payments and the cost of implementing such schemes. HVS and MHI schemes were implemented by Concern Worldwide through selected NGO health centres, referral hospitals, and private healthcare facilities in three City Corporations of Bangladesh from December 2016 to March 2020. A household survey with 1,294 enrolees, key-informant interviews, focus group discussions, consultative meetings, and document reviews were conducted for extracting data on healthcare utilisation, OOP payments, views of enrolees, and suggestions of implementers, and costs of services at the point of care. Healthcare utilisation including maternal, neonatal and child health (MNCH) services, particularly from medically trained providers, was higher and OOP payments were lower among the scheme enrolees compared to corresponding population groups in general. The beneficiaries were happy with their access to healthcare, especially for MNCH services, and their perceived quality of care was fair enough. They, however, suggested expanding the benefits package, supported by an additional workforce. The cost per beneficiary household for providing services per year was €32 in HVS and €15 in MHI scheme. HVS and MHI schemes enabled higher healthcare utilisation at lower OOP payments among the enrolees, who were happy with their access to healthcare, particularly for MNCH services. However, they suggested a larger benefits package in future. The provider's costs of the schemes were reasonable; however, there are potentials of cost containment by purchasing the health services for their beneficiaries in a competitive basis from the market. Scaling up such schemes addressing the drawback would contribute to achieving universal health coverage.

Delivering health insurance through informal financial groups: Evidence on moral hazard and adverse selection.

Moral hazard and adverse selection are potential explanations for missing health insurance in low-income countries. In recent years, informal financial institutions have attempted to complete health insurance markets by offering micro health insurance (MHI). We evaluate an MHI offered through informal financial institutions (Self-Help Groups) in Maharashtra, India. Exploiting random assignment of when villages were offered the MHI, we do not find support for MHI increasing health care utilization. In contrast, we do find evidence for adverse selection: enrollees are significantly more likely than non-enrollees to report poor health prior to the introduction of MHI. This adverse selection persists even when the MHI is offered as a group insurance to Self-Help Groups, as opposed to individual insurance. Our results suggest that MHI offered through informal financial groups may not suffer from moral hazard, but does fall short of eliminating adverse selection.

Exploring willingness to pay for health insurance and preferences for a benefits package from the perspective of women from low-income households of Karachi, Pakistan

BackgroundAchieving universal health coverage (UHC) and reduction in out of pocket (OOP) expenditures on health, is a critical target of the Sustainable Development Goals (SDG). In low-middle income countries, micro-health insurance (MHI) schemes have emerged as a useful financing tool for laying grounds for Universal Health Coverage. The aim of this study was to provide evidence for designing a feasible health insurance scheme targeted at urban poor, by exploring preferences for an insurance benefits package and co-payments among women from low-income households in Karachi, Pakistan.MethodsThis was a descriptive cross-sectional study, conducted using household surveys between July–August 2015. A total of 167 female beneficiaries of Benazir Income Support Programme (BISP), a large-scale cash transfer scheme targeted at low-income households, were recruited in Karachi through a mix of convenience and snowball sampling. Hypothetical insurance benefits packages for a prospective health insurance scheme were formulated to capture respondents’ preferences for health insurance benefits package and co-payments. All data was analyzed using Stata (version 13).ResultsRespondents reporting expenditure on OPD and hospitalization in the last 2 weeks were 93.4 and 11.9% respectively. The highest median expenditure was incurred on medicines. Out of the proposed benefits package, a majority (53%) of the study participants opted for the comprehensive benefits package that provided coverage for emergency care, hospitalization, OPD consultation, diagnostic tests and transportation. For the co-payment plan, 38.9% participants preferred no co-payments that is 100% insurance coverage of medicines followed by hospitalization (25.9%). Nearly half of the respondents (49.4%) chose outpatient consultation for 50% co-payment. A majority of the participants (65.3%) agreed to 100% co-payment for the transportation cost.ConclusionHealth insurance schemes can be introduced in urban areas, against collection of micro-payments, to prevent low-income households from facing financial catastrophe. A comprehensive benefits package covering emergency care, hospitalization, OPD consultation, diagnostic tests and transportation, is the most preferred among low-income beneficiaries.

Availability Does Not Mean Utilisation: Analysis of a Large Micro Health Insurance Programme in Pakistan

In recent years, several Micro Health Insurance (MHI) schemes have been initiated in low- and middle-income countries (LMIC) to meet the universal health coverage targets. Evidence on the utilization of these MHI schemes is scarce. Field experiences and lesson learning is crucial to effectively increase access to health care and offer protection against catastrophic health expenditure to the poorest population through the MHI schemes. This paper analyzes community utilization and factors affecting utilization of an MHI provided to the poorest rural households in eight districts of Sindh province of Pakistan. This initiative is part of a larger pro-poor European Union (EU) funded Sindh Union Council and Community Economic Strengthening Support (SUCCESS) Programme implemented by the Rural Support Programs (RSPs). The analysis draws on insurance utilization records and an internal assessment report by the RSPs Network (RSPN). The analysis provides qualitative experiences of the community, empanelled health care providers, the insurance agency and frontline management staff. Our analysis revealed that the overall utilization was very low (0.42%) and the highest number of cases treated at the hospital were of women utilizing obstetric and gynaecology related care. The scheme was noted to prevent catastrophic health expenditure in households that were able to successfully utilize the scheme. Key factors affecting utilization were identified to be around i) awareness creation, ii) distance to empanelled hospitals, and iii) access issues at the health facility level. We aim to add to the knowledge base around MHI for policy makers to design and implement more informed initiatives in the future.

Education and Experience as Determinants of Micro Health Insurance Enrolment.

Background: India faces a formidable challenge of providing universal health coverage to its uninsured population in the informal sector of the economy. Numerous micro health insurance (MHI) schemes have emerged as health financing mechanisms to reduce medical-illness-induced poverty. Existing research shows that the purchase of health insurance is most likely to be determined by health status, expected healthcare expenditure, and past health experiences in addition to socio-economic variables. We add to the understanding of various factors influencing enrolment in MHI from an Indian perspective. Methods: A survey was carried out to collect quantitative data in three districts in the state of Karnataka, India. Results: We show that education does not matter as significantly as experience does, in the determination of new insurance purchases. In other words, the importance of new insurance is not understood by those who are merely educated, but by those who have either fallen ill, or have previously seen the hazards of usurious borrowing. Conclusion: Our study provides deeper insights into the role of usurious borrowing and past illness in determining insurance purchases and highlights the formidable challenge of financial sustainability in the MHI market of India.

Micro-health insurance in dentistry: the road less travelled

Oral health is indeed a challenge for the urban poor. Majority of the patients spend from their pocket, which aggravates their financial condition. It is paramount for the government and the healthcare industry to adopt a value-based approach to redress the oral health lapses for the underserved population. Micro health insurance (MHI) can have a game changing effect on the oral healthcare space too, if concerned stakeholders build the right partner network. Aim of the study was to discuss the principal features, basic structure, and functioning of a few MHI schemes, and presents a hypothetical model of MHI which can be implemented in dentistry. Literature search was conducted in two main databases, pubmed and cochrane, using key phrases such as “community based health insurance,” “micro health insurance,” micro or community based health insurance,” and “health insurance and financial protection”. Articles published in last ten years with full texts were considered. 23 schemes were eligible for the systematic review. Our analysis shows that MHI, in the majority of cases, contributes to the financial protection of its beneficiaries, by reducing out of pocket health expenditure, catastrophic health expenditure, household borrowings and poverty. However, the studies did not affirm oral health benefits. The importance of oral healthcare in India is superficial. Focus on oral healthcare can be achieved only if the impending cost due to out of pocket payments can be supplanted with a more affordable and dynamic payment model. With MHI extended to oral healthcare, India can certainly achieve its SDG goal. It’s time to look beyond.

A critical analysis of purchasing arrangements in Kenya: the case of micro health insurance

BackgroundStrategic purchasing can ensure that financial resources are used in a way that optimally enhances the attainment of health system goals. A number of low- and middle-income countries, including Kenya, have experimented with micro health insurance (MHIs) as a means to purchase health services for the informal sector. This study aimed to examine the purchasing practices of MHIs in Kenya.MethodsThe study was guided by an analytical framework that compared purchasing practices of MHIs with the ideal actions for strategic purchasing along three pairs of principal-agent relationships (government-purchaser, purchaser-provider and citizen-purchaser). The study adopted a qualitative descriptive case study design with 2 MHIs as cases. Data were collected through document reviews (regulation, marketing materials, websites) and semi-structured interviews with key informants (n = 27).ResultsThe regulatory framework for MHIs did not adequately support strategic purchasing practice and was exacerbated by poor coordination between health and financial sectors. The MHIs strategically contracted health providers over whom they could exercise bargaining power, sometimes at the expense of quality. There were no clear channels for beneficiaries to provide timely feedback to the purchaser. MHIs premium payments were family-based, low-cost and offered limited benefits. Coverage was based on ability to pay, which may have excluded low-income households from membership.ConclusionsAdequate policy, legal and regulatory frameworks that integrate MHIs into the broader health financing system and support strategic purchasing practices are required. The state departments responsible for finance and health should form coordinating structures that ensure that MHI’s role in universal health coverage is owned across all relevant sectors, and that actors, such as regulators, perform in a coordinated manner. The frameworks should also seek to align purchasers’ relationships with providers so that clear and consistent signals are received by providers from all purchasing mechanisms present within the health system.

The effect of consensus on demand for voluntary micro health insurance in rural India.

IntroductionThis study deals with examining factors that catalyze demand for community-based micro health insurance (MHI) schemes. We hypothesize that demand for health insurance is a collective decision in the context of informality and poverty. Our hypothesis challenges the classical theory of demand which posits individual expected diminishing utility. We examine factors beyond the traditional exogenous variables.MethodsThis study uses data collected through a household survey conducted among self-help groups in rural India in the states of Uttar Pradesh and Bihar before the implementation of three community-based MHI schemes. Additional information was extracted from the management information system maintained by the schemes. At the first step, we compared the estimated probability of a household joining the scheme (obtained by applying logistic regression) to the actual uptake. In the next step, we analyzed the role of consensus within groups on demand for health insurance (by applying ordinary least square regressions).ResultsThe results of the logistic regressions indicated that exogenous household characteristics could not explain the probability of joining health insurance. We observed that group consensus on several critical issues, such as the price of the insurance, perceptions about exposure to adverse health events, and perceptions of the quality of service of local health care providers, was the important determinant of demand for insurance.ConclusionBased on the analysis, we reject the null hypothesis that demand is an individual decision at the household level. The analysis upholds the assumption that demand is created through a process of consensus building on perceptions of risk exposure, welfare gains from the insurance, and quality of local health care provision. Success in catalyzing demand for health insurance in the informal sector depends on encouraging group dialog.

Extending health insurance coverage to the informal sector: Lessons from a private micro health insurance scheme in Lagos, Nigeria.

As a growing number of low- and middle-income countries commit to achieving universal health coverage, one key challenge is how to extend coverage to informal sector workers. Micro health insurance (MHI) provides a potential model to finance health services for this population. This study presents lessons from a pilot study of a mandatory MHI plan offered by a private insurance company and distributed through a microfinance bank to urban, informal sector workers in Lagos, Nigeria. Study methods included a survey of microfinance clients, key informant interviews, and a review of administrative records. Demographic, health care seeking, and willingness-to-pay data suggested that microfinance clients, particularly women, could benefit from a comprehensive MHI plan that improved access to health care and reduced out-of-pocket spending on health services. However, administrative data revealed declining enrollment, and key informant interviews further suggested low use of the health insurance plan. Key implementation challenges, including changes to mandatory enrollment requirements, insufficient client education and marketing, misaligned incentives, and weak back-office systems, undermined enrollment and use of the plan. Mandatory MHI plans, intended to mitigate adverse selection and facilitate private insurers' entry into new markets, present challenges for covering informal sector workers, including when distributed through agents such as a microfinance bank. Properly aligning the incentives of the insurer and the agent are critical to effectively distribute and service insurance. Further, an urban environment presents unique challenges for distributing MHI, addressing client perceptions of health insurance, and meeting their health care needs.

Who enrols in voluntary micro health insurance schemes in low-resource settings? Experience from a rural area in Bangladesh

ABSTRACTBackground: Micro health insurance (MHI) has proved to be a potential health-financing tool for many developing countries. Bangladesh also included MHI in its current health-financing strategy which aims to achieve universal health coverage. However, low uptake, low renewal and high dropouts have historically challenged financial sustainability of these schemes.Objective: This study aims to identify factors influencing people from low-resource settings, particularly those from Bangladesh, to enrol in MHI schemes.Methods: The study analyses the ‘Amader Shasthya’ MHI scheme operating in Chakaria, a sub-district under Cox’s Bazar district, Bangladesh. A household survey was carried out during May–June 2016 among 2,000 households from the scheme coverage area. The Outreville’s insurance-demand framework was used to identify enrolment influencing factors. Multivariate logistic regression analysis was carried out to identify significant influencing factors of enrolment.Results: Enrolment influencing factors were identified in four dimensions: economic, socio-cultural, demographic and structural. Households with the main income earner having 10+ years of schooling (odds 1.9 [CI 1.2–2.9] compared to illiterate), having financial literacy (odds 1.5 [CI 1.2–1.8] compared to financially illiterate) and being a public/private service holder (odds 1.6 [CI 1.1–2.4] compared to menial labour) were more likely to enrol. Membership in development programmes of NGOs also influenced enrolment decision significantly (odds 1.3 [CI 1.0–1.5]). The presence of chronic illness in household encouraged enrolment (odds 1.5 [CI 1.2–1.8]). Households living closer to health centres were more likely to enrol (odds 2.1 [CI 1.6–2.7]) compared to those living further away.Conclusion: The findings are expected to have significant implications in terms of designing similar health insurance schemes, particularly in terms of designing demand-driven and context adapted schemes that have greater potential to attract a larger client pool, ensure effective risk pooling and eventually expedite the achievement of universal health coverage in low-resource settings.

Why Members Dropout? An Evaluation of Factors Affecting Renewal in Micro Health Insurance

Micro health insurance (MHI) is an important mechanism to fight iatrogenic poverty in India. Its sustainability and viability depends, to a greater extent on the renewal of membership. This article evaluates the factors that influence renewal decisions in Sampoorna Suraksha Programme (SSP) in Karnataka. This study shows income class and chronic illness in the family to determine the renewability. The findings indicate adverse selection since low-income low-risk and high-income low-risk families dropout. From the social welfare point of view, renewal from high-risk low-income families is welcome; yet this should not jeopardize resource mobilization of SSP. Sustainable and viable operations of SSP depends on continued membership of insured population that can be achieved through external financial assistance for the poorest, wider network of hospitals and increased awareness on health insurance. Dropout rate in any MHI scheme should be kept very low to achieve deeper penetration and wider coverage especially in India where large percentage of population falls outside the insurance ambit.

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

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.

Socioeconomic and programmatic determinants of renewal of membership in a voluntary micro health insurance scheme: evidence from Chakaria, Bangladesh

ABSTRACT Background: Out-of-pocket (OOP) healthcare expenditure is a major obstacle for achieving universal health coverage in low-income countries including Bangladesh. Sixty-three percent of the USD 27 annual per-capita healthcare expenditure in Bangladesh comes from individuals’ pockets. Although health insurance is a financial tool for reducing OOP, use of such tools in Bangladesh has been limited to some small-scale voluntary micro health insurance (MHI) schemes run by non-governmental organizations (NGO). The MHI, however, can orient people on health insurance concept and provide learning for product development, implementation, barriers to enrolment, membership renewal, and other operational challenges and solutions. Keeping this in mind, icddr,b in 2012 initiated a pilot MHI, Amader Shasthya, in Chakaria, Bangladesh. This paper explores the determinants of membership renewal in this scheme, which is a perpetual challenge for MHI. Objective: Identify socioeconomic and programmatic determinants and their effects on membership renewal in a voluntary MHI scheme. Methods: Data came from the online management information system of the scheme and Health and Demographic Surveillance System of Chakaria, covering the period February 2012–May 2015. Association between renewal and independent variables was examined using cross-tabular and logistic regression analyses. Results: Nearly 20% of households in the catchment area ever enroled in the scheme, and 38% renewed membership over the initial 3 years of operation. Frequency of consultation with healthcare providers, benefits received, proximity of member’s residence to health facility, socioeconomic status, educational level, and age of the household head showed significant positive association with renewal of membership. Conclusions: Villagers’ enrolment in the scheme indicated that even in poor economic and literacy conditions people can be motivated to enrol in insurance schemes. Degree of service utilization and benefits received can greatly enhance the probability of membership renewal, which can be ensured with good quality of services and ease of access.

What factors drive heterogeneity of preferences for micro-health insurance in rural Malawi?

Investigating the factors that drive differences in preferences for health insurance products among rural populations is a relevant policy issue that has so far received little attention. This study used a discrete choice experiment to explore heterogeneity of preferences for a prospective micro-health insurance (MHI) product in Malawi. Through an extensive qualitative study, six attributes, each associated with three levels, were derived and used to construct a D-efficient design. The attributes included unit of enrollment, management structure, health service benefit package, copayment levels, transportation coverage and monthly premium. The experiment was interviewer administered to a stratified random sample of household heads and their spouse(s). Using mixed logit and generalized multinomial logit models, respondent characteristics were interacted with MHI attributes to explore heterogeneity of preferences. The results showed that those in the higher age group (≥55 years) and those from households with higher household expenditure had significantly higher preferences for comprehensive and medium benefit packages than for a basic package. Those from households that incurred any healthcare expenditure within the past 4 weeks had lower preferences for the core family as a unit of enrollment than the individual, and higher preferences for coverage of transport costs. Women and non-micro-finance members had higher preferences for 25% copayment than for 50% copayment. There was evidence of scale heterogeneity signifying that the observed preference variations could have resulted from scale and variance differences, rather than real variations in the taste of respondents. To attract the relatively older and wealthier, prospective MHI should offer comprehensive health services benefit packages. Premium exemptions or subsidies should also be offered to the poor. Lower copayments can provide an incentive for women and non-micro-finance members, whilst coverage of transport costs can also attract those with recent history of incurring out-of-pocket healthcare expenditure to accept MHI.

Illness Makes Credit Sick: Can Health Insurance Rescue the Poor from Exploitative Credit?

Health shocks cripple poor households through hardship financing and impoverishment. Borrowing from non-market sources is the most common strategy used by these households, which eventually pushes them into a debt trap. Micro health insurance (MHI) is expected to reduce the reliance on these sources of finance by ensuring financial protection. We use the data from a cross-sectional study undertaken in Karnataka to investigate any association between MHI and non-market credit during health shocks. The sample size was 1,146 consisting of 416 insured households and the remaining being uninsured. The analysis of the data shows inadequate risk protection provided by MHI giving rise to borrowing, sale of assets and liquidation of savings by insured individuals. Yet, they relied less on usurious credit compared with uninsured individuals. This finding not only substantiates the importance of MHI in health-care financing but also highlights the need for affordable and comprehensive financing mechanisms to replace non-market institutions with formal insurance.

The role of micro health insurance in providing financial risk protection in developing countries--a systematic review.

BackgroundOut of pocket payments are the predominant method of financing healthcare in many developing countries, which can result in impoverishment and financial catastrophe for those affected. In 2010, WHO estimated that approximately 100 million people are pushed below the poverty line each year by payments for healthcare. Micro health insurance (MHI) has been used in some countries as means of risk pooling and reducing out of pocket health expenditure. A systematic review was conducted to assess the extent to which MHI has contributed to providing financial risk protection to low-income households in developing countries, and suggest how the findings can be applied in the Pakistani setting.MethodsWe conducted a systematic search for published literature using the search terms “Community based health insurance AND developing countries”, “Micro health insurance AND developing countries”, “Mutual health insurance AND developing countries”, “mutual OR micro OR community based health insurance” “Health insurance AND impact AND poor” “Health insurance AND financial protection” and “mutual health organizations” on three databases, Pubmed, Google Scholar and Science Direct (Elsevier). Only those records that were published in the last ten years, in English language with their full texts available free of cost, were considered for inclusion in this review. Hand searching was carried out on the reference lists of the retrieved articles and webpages of international organizations like World Bank, World Health Organization and International Labour Organization.ResultsTwenty-three articles were eligible for inclusion in this systematic review (14 from Asia and 9 from Africa). Our analysis shows that MHI, in the majority of cases, has been found to contribute to the financial protection of its beneficiaries, by reducing out of pocket health expenditure, catastrophic health expenditure, total health expenditure, household borrowings and poverty. MHI also had a positive safeguarding effect on household savings, assets and consumption patterns.ConclusionOur review suggests that MHI, targeted at the low-income households and tailored to suit the cultural and geographical structures in the various areas of Pakistan, may contribute towards providing protection to the households from catastrophe and impoverishment resulting from health expenditures. This paper emphasizes the need for further research to fill the knowledge gap that exists about the impact of MHI, using robust study designs and impact indicators.