Dror David Mark, Majumdar Atanu, Chakraborty Arpita
Research Department, Micro Insurance Academy, Garhi, East of Kailash, New Delhi, India,
School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, the Netherlands,
Risk Manag Healthc Policy. 2018 Sep 11;11:139-158. doi: 10.2147/RMHP.S170299. eCollection 2018.
This 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.
This 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).
The 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.
Based 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.
本研究旨在探讨促使基于社区的小额健康保险（MHI）计划需求增长的因素。我们假设，在非正规性和贫困背景下，健康保险需求是一个集体决策。我们的假设挑战了认为个体预期效用递减的经典需求理论。我们研究了传统外生变量之外的因素。
本研究使用的数据是在印度北方邦和比哈尔邦实施三项基于社区的MHI计划之前，对农村自助团体进行的家庭调查中收集的。此外，还从这些计划维护的管理信息系统中提取了信息。第一步，我们将家庭加入该计划的估计概率（通过应用逻辑回归获得）与实际参保情况进行了比较。第二步，我们分析了团体内部共识对健康保险需求的作用（通过应用普通最小二乘法回归）。
逻辑回归结果表明，家庭的外生特征无法解释加入健康保险的概率。我们观察到，在几个关键问题上的团体共识，如保险价格、对遭遇不良健康事件的认知以及对当地医疗服务提供者服务质量的认知，是保险需求的重要决定因素。
基于分析，我们拒绝了需求是家庭层面个体决策的原假设。该分析支持了这样一种假设，即需求是通过就风险暴露认知、保险福利收益以及当地医疗服务提供质量达成共识的过程而产生的。在非正规部门催化健康保险需求的成功取决于鼓励团体对话。
