How private, voluntary health insurance can work in developing countries

Health Affairs

Volumn 28, Issue 6, 2009, Pages 1778-1787

  Pauly, Mark V ^a   Blavin, Frederic E ^a   Meghan, Sudha ^a  

^a UNIVERSITY OF PENNSYLVANIA   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

CLINICAL TRIAL; CONFERENCE PAPER; DEVELOPING COUNTRY; HEALTH INSURANCE; HEALTH SERVICE; HEALTH SURVEY; HUMAN; MULTICENTER STUDY; PHYSICIAN; RISK FACTOR;

COOPERATIVE BEHAVIOR; DEVELOPING COUNTRIES; HEALTH EXPENDITURES; HUMANS; INCOME; INSURANCE, HEALTH; ORGANIZATIONAL OBJECTIVES; PRIVATE SECTOR; RISK ASSESSMENT;

EID: 77952130942     PISSN: 02782715     EISSN: 15445208     Source Type: Journal    
DOI: 10.1377/hlthaff.28.6.1778     Document Type: Conference Paper

References (15)

1. Pauly MV, Zweifel P. Market outcomes, regulation, and recommendations for policy. In: Preker AS, Scheffler R, Bassett M, editors. Private health insurance in devdoping countries: friend or foe? Washington (DC): World Bank; 2006. p. 115-46.
2. Phelps CE. Health economics. 3rd ed Boston (MA): Addison Wesley, 2003. p. 323.
3. For a cross-country analysis of medical spending patterns (but not insurance demand) using these data, see Wagner A, Reiss S, Johnson A, Ross-Degnan D. Results of feasibility study using World Health Survey data to measure medicines need, use, and out-of-pocket expenditures in eight low and lower-middle income countries [Internet]. Boston (MA): World Health Organization Collaborating Center in Pharmaceutical Policy, Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care; 2007 Mar [cited 2009 Oct 1]. Available from: http://www.dfidhealthrc.org/MeTA/MeTA- equity-workshop.html
4. World Health Organization. The world health report 2003: shaping the future [Internet]. Geneva (Switzerland): WHO; 2003 [cited 2008 May 22]. Available from http://www.who.int/ whr/2003/en/whr03-en.pdf
5. Ferguson B, Tandon A, Gakidou E, Murray CJL Estimating permanent income using indicator variables. In: Murray CJL Evans DB, editors. Health system performance assessment: debates, methods, and empiricism. Geneva (Switzerland): WHO; 2003.
6. Our assumption here is that unusually high medical spending will not cut immediately into consumption spending but instead will be financed by borrowing or using assets. Hence, net consumption spending plus expected medical spending is an alternative estimate of the household's sustainable consumption spending and real income.
7. For all countries, except for Georgia, we also deleted units where the household informant reported having health insurance. Nearly all households in Georgia reported having health insurance and were induded in the final sample.
8. Regression results are induded in a statistical appendix, available online at http://content .healthaffairs.org/cgi/content/full/28/6/1778/DC1.
9. Garber AM, Phelps CE. Economic foundations of cost-effectiveness analysis. J Health Econ. 199746 (1)1-31.
10. Empirical estimates of the coefficient of relative risk-aversion actually cover an enormous range, from 0.1 to more than 10.0. Estimates generated from individual portfolio choice are generally higher than those generated from experimental studies of what gambles people say they will accept. We chose 2.0 based on the recent discussion by Donald Meyer and Jack Meyer of a table in which most estimates are dose to or overlap the value of 2.0. Meyer D, Meyer J. Relative risk aversion: what do we know? J Risk Uncertainty. 2005;31(3):243-62.
11. Binswanger H. Attitudes toward risk experimental measurement in rural India. Am J Agr Ecoa 1980;62(3):395-407. This work fails to support the hypothesis that risk-aversion differs in developing and developed countries.
12. Cardenas JC, Carpenter J. Behavioural devdopment economics: lessons from field labs in the devdoping world J Dev Stud 2008;44(3):311-38. This is a more recent summary of work that also fails to support the hypothesis of varying risk-aversion.
13. Asociación de ISAPRES A.G. ISAPRE: the private health insurance in Chile. Santiago (Chile): Asociación de ISAPRES A.G.; 1998.
14. Mahal A. Health policy challenges for India: private health insurance and lessons from the international experience. In: Srinivasan TN, editor. Trade, finance, and investment in South Asia. New Delhi (India): Social Science Press; 2002. p. 434.
15. One way to sustain segmentation of income or wealth is to vary the level of amenity in covered services; in Singapore, for example, the presence or absence of air conditioning for inpatient care seems to keep the better-off from using wards meant for insurance plans targeted to lower-income people.