Institute of Public Health, Medical Faculty, University of Heidelberg, Heidelberg, Germany; Department of Planning and Management, University for Development Studies, Wa, Ghana.
Centre for Research on Health and Social Care Management - CERGAS, Department of Policy Analysis and Public Management, Bocconi University, Italy.
Soc Sci Med. 2014 Nov;120:160-8. doi: 10.1016/j.socscimed.2014.09.021. Epub 2014 Sep 16.
There is a limited understanding of preferences for micro health insurance (MHI) as a strategy for moving towards universal health coverage. Using a discrete choice experiment (DCE), we explored community preferences for the attributes and attribute-levels of a prospective MHI scheme, aimed at filling health coverage gaps in Malawi. Through a qualitative study informed by a literature review, we identified six MHI attributes (and attribute-levels): unit of enrollment, management structure, health service benefit package, copayment levels, transportation coverage, and monthly premium per person. Qualitative data was collected from 12 focus group discussions and 8 interviews in August-September, 2012. We constructed a D-efficient design of eighteen choice-sets, each comprising two MHI choice alternatives and an opt-out. Using pictorial images, trained interviewers administered the DCE in March-May, 2013, to 814 household heads and/or their spouse(s) in two rural districts. We estimated preferences for attribute-levels and relative importance of attributes using conditional and nested logit models. The results showed that all attribute-levels except management by external NGO significantly influenced respondents' choice behavior (P<0.05). These included: enrollment as core nuclear family (odds ratio (OR)=1.1574), extended family (OR=1.1132), compared to individual; management by community committee (OR=0.9494) compared to local micro finance institution; comprehensive health service package (OR=1.4621), medium service package (OR=1.2761), compared to basic service package; no copayment (OR=1.1347), 25% copayment (OR=1.1090), compared to 50% copayment; coverage of all transport (OR=1.5841), referral and emergency transport (OR=1.2610), compared to no transport; and premium (OR=0.9994). The relative importance of attributes is ordered as: transport, health services benefits, enrollment unit, premium, copayment, and management. To maximize consumer utility and encourage community acceptance of MHI, potential MHI schemes should cover transport costs, offer a comprehensive benefit package, define the core family as the unit of enrollment, avoid high copayments, and be managed by a competent financial institution.
人们对小额医疗保险（MHI）作为实现全民健康覆盖战略的偏好了解有限。本研究采用离散选择实验（DCE），探索社区对拟议的 MHI 计划的属性和属性水平的偏好，旨在填补马拉维的健康覆盖缺口。通过文献回顾的定性研究，我们确定了六项 MHI 属性（及其属性水平）：参保单位、管理结构、医疗服务福利包、自付额水平、交通覆盖范围和每人每月保费。2012 年 8 月至 9 月，通过 12 个焦点小组讨论和 8 次访谈收集了定性数据。我们构建了一个 18 个选择集的 D 有效设计，每个选择集包含两个 MHI 选择方案和一个退出选项。2013 年 3 月至 5 月，使用图画图像，经过培训的访谈员在两个农村地区对 814 户户主及其配偶（或配偶）进行了 DCE 调查。我们使用条件和嵌套对数模型估计了属性水平的偏好和属性的相对重要性。结果表明，除管理机构为外部 NGO 外，所有属性水平均显著影响受访者的选择行为（P<0.05）。这些因素包括：以核心核心家庭（优势比（OR）=1.1574）、扩展家庭（OR=1.1132）而非个人参保（OR）；以社区委员会（OR=0.9494）而非当地小额金融机构进行管理（OR）；以全面健康服务包（OR=1.4621）、中等服务包（OR=1.2761）而非基本服务包进行管理（OR）；无自付额（OR=1.1347）、25%自付额（OR=1.1090）而非 50%自付额（OR）；涵盖所有交通（OR=1.5841）、转诊和紧急交通（OR=1.2610）而非无交通（OR）；以及保费（OR=0.9994）。属性的相对重要性顺序为：交通、健康服务福利、参保单位、保费、自付额和管理。为了最大限度地提高消费者效用并鼓励社区接受 MHI，潜在的 MHI 计划应涵盖交通费用，提供全面的福利包，将核心家庭定义为参保单位，避免高自付额，并由有能力的金融机构管理。
