Methodology for Reviewing Private Voluntary Health Insurance
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and Peter Zweifel in Friend or Foe against the empirical evidence from the 12 case studies in the present volume (Pauly 2007; Zweifel, Krey, and Tagli 2007; and Zweifel and Pauly 2007).
Country Case Studies The case studies use both quantitative analysis of microlevel household survey data and qualitative analysis of key policy, management, organizational, and institutional determinants of good outcomes, using an adapted version of the methodology developed for research on community financing (Preker and Carrin 2005). The case studies use qualitative techniques to describe insurance schemes’ policy, institutional, organizational, and management attributes that may lead to strengths and weaknesses similar to those in the framework used for the review of literature described above and summarized in table A.1. The case studies use quantitative analysis of microlevel household survey techniques to shed light on five possible benefits of voluntary health insurance. Possible market indicators for each of the major benefits are indicated in table A.2. Volume contributors searched various household budget surveys, Living Standard Measurement Surveys (LSMS), and Demographic and Health Surveys (DHS) for voluntary health insurance data. Most surveys do not allow identification of households with access to voluntary health insurance. Therefore, the subset of countries that can be examined using this methodology is small.
Impact of PVHI on Financial Protection and Consumption Smoothing To gauge the impact of voluntary health insurance on financial protection and consumption smoothing, a measure with the following properties is needed: • Given income, premiums, and the distribution of medical spending, the measure rises when insurance coverage increases. • Given income, premiums, and insurance coverage, the measure falls when the distribution of spending becomes more variable (higher relative probability of high cost).
TABLE A.2
Market Indicators for Benefits of Voluntary Health Insurance
Dependent variable
Possible market indicators
Independent variables
Financial protection
Household expenditure
Consumption smoothing
Nonmedical goods and services consumption
All policy, organizational, institutional, and management variables and factors in PRSP framework
Access to care
Service utilization
Labor
Labor market and productivity
Enrolment
Household members
Source: Preker, Scheffler, and Bassett 2007.