Department of Primary and Community Care, Radboud University Medical Center, The Netherlands.
Health Policy. 2010 May;95(2-3):166-73. doi: 10.1016/j.healthpol.2009.11.017. Epub 2009 Dec 22.
This paper outlines the potential strategies to identify the poor, and assesses their feasibility, efficiency and equity. Analyses are illustrated for the case of premium exemptions under National Health Insurance (NHI) in Ghana.
A literature search in Medline search was performed to identify strategies to identify the poor. Models were developed including information on demography and poverty, and costs and errors of in- and exclusion of these strategies in two regions in Ghana.
Proxy means testing (PMT), participatory welfare ranking (PWR), and geographic targeting (GT) are potentially useful strategies to identify the poor, and vary in terms of their efficiency, equity and feasibility. Costs to exempt one poor individual range between US$11.63 and US$66.67, and strategies may exclude up to 25% of the poor. Feasibility of strategies is dependent on their aptness in rural/urban settings, and administrative capacity to implement. A decision framework summarizes the above information to guide policy making.
We recommend PMT as an optimal strategy in relative low poverty incidence urbanized settings, PWR as an optimal strategy in relative low poverty incidence rural settings, and GT as an optimal strategy in high incidence poverty settings. This paper holds important lessons not only for NHI in Ghana but also for other countries implementing exemption policies.
本文概述了识别贫困人口的潜在策略，并评估了它们的可行性、效率和公平性。以加纳国家健康保险（NHI）保费豁免为例进行了分析。
在 Medline 搜索中进行了文献检索，以确定识别贫困人口的策略。在加纳的两个地区，针对这些策略的人口统计学和贫困信息、成本以及纳入和排除这些策略的误差，建立了模型。
代理手段测试（PMT）、参与式福利排名（PWR）和地理定位（GT）是潜在有用的识别贫困人口的策略，它们在效率、公平性和可行性方面存在差异。豁免一个贫困人口的成本在 11.63 美元至 66.67 美元之间，策略可能会排除多达 25%的贫困人口。策略的可行性取决于其在农村/城市环境中的适宜性和实施的行政能力。决策框架总结了上述信息，以指导政策制定。
我们建议在相对贫困发生率较低的城市化地区采用 PMT 作为最佳策略，在相对贫困发生率较低的农村地区采用 PWR 作为最佳策略，在贫困发生率较高的地区采用 GT 作为最佳策略。本文不仅为加纳的 NHI，也为其他实施豁免政策的国家提供了重要的经验教训。
