Publications

Microinsurance is an emerging solution in tackling issues of poverty and vulnerability. We are always interested in determining how to increase the efficiency, effectiveness and sustainability of microinsurance solutions and we want to share our research results with you.

Our Innovative Research:

Healthcare seeking behaviour among self-help group households in Rural Bihar and Uttar Pradesh, India

Authors: Wameq A. Raza1,2*, Ellen Van de Poel3, Pradeep Panda4, David Dror5 and Arjun Bedi6

Year: 2016

Journal: BMC Health Services Resea

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Abstract: Abstract :Background: In recent years, supported by non-governmental organizations (NGOs), a number of community based health insurance (CBHI) schemes have been operating in rural India. Such schemes design their benefit packages according to local priorities. This paper examines healthcare seeking behaviour among self-help grouphouse holds with a view to understanding the implications for the benefit packages offered by such schemes. Methods: We use cross-sectional data collected from two of India’s poorest states and estimate an alternativespecific conditional logit model to examine healthcare…read more

Impact of community-based health insurance in rural India on self-medication & financial protection of the insured

Authors: David M. Dror1, Arpita Chakraborty1,2, Atanu Majumdar1, Pradeep Panda1 & Ruth Koren3

Year: 2015

Journal: THE INDIAN JOURNAL OF MEDICAL RESEARCH

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Abstract: Background & objectives: The evidence-base of the impact of community-based health insurance (CBHI) on access to healthcare and financial protection in India is weak. We investigated the impact of CBHI in rural Uttar Pradesh and Bihar States of India on insured households’ self-medication and financial position. Methods: Data originated from (i) household surveys, and (ii) the Management Information System of each CBHI. Study design was “staggered implementation” cluster randomized controlled trial with enrollment of one-third of the treatment group in…read more

Building awareness to health insurance among the target population of community-based health insurance schemes in rural India

Authors: Pradeep Panda1, Arpita Chakraborty1 and David M. Dror1,2

Year: 2015

Journal: Tropical Medicine and International Health

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Abstract: objective To evaluate an insurance awareness campaign carried out before the launch of three community-based health insurance (CBHI) schemes in rural India, answering the questions: Has the awareness campaign been successful in enhancing participants’ understanding of health insurance? What awareness tools were most useful from the participants’ point of view? Has enhanced awareness resulted in higher enrolment? methods Data for this analysis originates from a baseline survey (2010) and a follow-up survey (2011) of more than 800 households in the…read more

Renewing membership in three community-based health insurance schemes in rural India

Authors: Pradeep Panda, Arpita Chakraborty, Wameq Raza and Arjun Bedi

Year: 2015

Journal: Internation Institute of Social Studies

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Abstract: Low renewal rate is a key challenge facing the sustainability of Community-based Health Insurance (CBHI) schemes. While there is a large literature on initial enrolment into such schemes, there is limited evidence on the factors that impede renewal. This paper uses longitudinal data to analyse what determines renewal, both one and two years after the introduction of three CBHI schemes, which have been operating in rural Bihar and Uttar Pradesh since 2011. We find that initial scheme uptake is about…read more

Private non-degree practitioners and spatial access to out-patient care in rural India

Authors: Vikram Ranga , Pradeep Panda

Year: 2015

Journal: Geo Journal

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Abstract: Most rural areas in the developing countrieslack access to qualified out-patient (OPD) care. The gap in health services provision arises, due to lack of qualified doctors and is oftentimes filled by unqualified doctors who are also known as private non-degree practitioners (PNDPs). Despite their dominance, their presence is often neglected in access to health care studies. This leaves a scenario which lacks informal, but predominant, care. This paper uses a mix-method approach, combining exhaustive quantitative census of all health care providers along with location details…read more

Mobilizing community-based health insurance to enhance awareness & prevention of airborne, vector-borne & waterborne diseases in rural India

Authors: Pradeep Panda*, Arpita Chakraborty* & David M. Dror*,**

Year: 2014

Journal: THE INDIAN JOURNAL OF MEDICAL RESEARCH

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Abstract: Background & objectives: Despite remarkable progress in airborne, vector-borne and waterborne diseases in India, the morbidity associated with these diseases is still high. Many of these diseases are controllable through awareness and preventive practice. This study was an attempt to evaluate the effectiveness of a preventive care awareness campaign in enhancing knowledge related with airborne, vector-borne and waterborne diseases, carried out in 2011 in three rural communities in India (Pratapgarh and Kanpur- Dehat in Uttar Pradesh and Vaishali in Bihar).…read more

Defining Indicators for Impact Assessment

Authors: Conor Doyle and Pradeep Panda

Year: 2014

Book: A Practical Guide to Impact Assessments in Microinsurance

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Abstract: Chapter 9 of  The new book “A Practical Guide to Impact Assessments in Microinsurance” is the result of the work of the Microinsurance Network Impact Working Group in collaboration with 25 authors, and aims to guide donors and policy makers, academic scholars, and microinsurance practitioners in designing and carrying out high quality impact evaluations in microinsurance. Microinsurance is a fast-growing sector providing innovative tools for risk protection of low income people. Impact evaluations are key to gaining more insight into…read more

What is Microinsurance?

Authors: David M. Dror and David Piesse

Year: 2014

Book: A Practical Guide to Impact Assessments in Microinsurance

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Abstract: Chapter 2 of  The new book “A Practical Guide to Impact Assessments in Microinsurance” is the result of the work of the Microinsurance Network Impact Working Group in collaboration with 25 authors, and aims to guide donors and policy makers, academic scholars, and microinsurance practitioners in designing and carrying out high quality impact evaluations in microinsurance. Microinsurance is a fast-growing sector providing innovative tools for risk protection of low income people. Impact evaluations are key to gaining more insight into…read more

In a Nutshell: Impact Assessments in Microinsurance

Authors: Ralf Radermacher and Katja Roth

Year: 2014

Book: A Practical Guide to Impact Assessments in Microinsurance

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Abstract: Chapter 1 of  The new book “A Practical Guide to Impact Assessments in Microinsurance” is the result of the work of the Microinsurance Network Impact Working Group in collaboration with 25 authors, and aims to guide donors and policy makers, academic scholars, and microinsurance practitioners in designing and carrying out high quality impact evaluations in microinsurance. Microinsurance is a fast-growing sector providing innovative tools for risk protection of low income people. Impact evaluations are key to gaining more insight into…read more

The Demand for (Micro) Health Insurance in the Informal Sector

Authors: David M. Dror and Lucy A. Firth

Year: 2014

Book: The Geneva Papers 2014, 00, (1–19)

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Abstract: We identify the need for a theory of demand for health insurance suited to the informal sector in low- and middle income countries (LMIC) where some 3 billion people lack health cover. Excluded from formal governance structures, they rely on informal arrangements by which rules in-use shape choices, behaviours and decisions. We explore the fundamental assumptions of standard economic theories of demand for health insurance in the light of arguments from the literature and field evidence. We show that the…read more

Spatial Accessibility to In-Patient Health Care in Rural Northern India

Authors: Ranga, Vikram and Pradeep Panda

Year: 2014

Book: Geospatial Health, 8(2), pp. 545-556.

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Abstract: Access to health care in rural areas for local populations as well as for policy makers as well as developing countries. This paper examines spatial access to in-patient health care in Northern India.read more

Health Microinsurance Programs in Developing Countries

Authors: Dror D.M.

Year: 2014

Journal: In: Anthony J. Culyer (ed.), Encyclopedia of Health Economics, Vol 1. San Diego: Elsevier; 2014. pp. 412-421.

Abstract: Prof. David Dror's article published on health microinsurance in the Encyclopedia of Health Economics can be found on this link.read more

Implementing a Participatory Model of Micro Health Insurance Among Rural Poor with Evidence from Nepal

Authors: David M. Dror, Atanu Majumdar, Pradeep Panda, Denny John, Ruth Koren

Year: 2014

Journal: The Geneva Papers (April 2014) Vol. 39, pp 280–303

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Abstract: Abstract: This paper reports on two voluntary, contributory, contextualized, community-based health insurance (CBHI) schemes, launched in Dhading and Banke (Nepal) in 2011. The implementation followed a four stage process: initiating (baseline survey), involving (awareness generation and engaging community in benefit-package-design), launch (enrollment and training of selected community members) and post launch (viable claims ratio; settled within satisfactory time, sustainable affiliation). Both schemes were successful on four key parameters: effective planning; affiliation (grew from 0 to about 10,000) and renewals (>65%);…read more

Enrolment in Community-based Health Insurance Schemes in Rural Bihar and Uttar Pradesh, India

Authors: Pradeep Panda, Arpita Chakraborty, David M Dror and Arjun S Bedi

Year: 2014

Journal: Health Policy Plan 2014 Dec;29(8):960-74

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Abstract: This article assesses insurance uptake in three community-based health insurance (CBHI) schemes located in rural parts of two of India's poorest states and offered through women's self-help groups (SHGs). We examine what drives uptake, the degree of inclusive practices of the schemes and the influence of health status on enrolment. The most important finding is that a household's socio-economic status does not appear to substantially inhibit uptake. In some cases scheduled caste/scheduled tribe households are more likely to enrol. Second,…read more

Estimating Willingness-to-Pay for Health Insurance Among Rural Poor in India By Reference to Engel’s Law

Authors: Erika Binnendijk, David M Dror, Eric Gerelle and Ruth Koren

Year: 2013

Journal: Social Science & Medicine 76 (2013) pp. 67-73

Book: Book Here

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Abstract: Community-Based Health Insurance (CBHI) (a.k.a. micro health insurance) is a contributory health insurance among rural poor in developing countries. As CBHI schemes typically function with no subsidy income, the schemes’ expenditures cannot exceed their premium income. A good estimate of Willingness-To-Pay (WTP) among the target population affiliating on a voluntary basis is therefore essential for package design. Previous estimates of WTP reported materially and significantly different WTP levels across locations (even within one state), making it necessity to base estimates…read more

Spatial Research Methodology Supplementing Randomized Control Trials: Learning from a Study of Community-based Health Insurance Schemes in India

Authors: Shikha Dixit and Pradeep Panda

Year: 2013

Journal: International Journal of Geoinformatics, Vol 9, No. 3

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Abstract: Most of the cluster randomized control trials (CRCTs) are conducted in a geographical area, but the present CRCT evaluation model does not capture "place" component. CRCTs reported without providing the information on spatio-temporal changes taking place at the experiment site, during the course of the intervention, present only a part of the picture and also pose a great difficulty in finding out casual relationship between the intervention and outcome. We conclude that a complete evaluation model should have tools to…read more

Hardship Financing of Healthcare Among Rural Poor in Orissa, India

Authors: Erika Binnendijk, Ruth Koren and David M Dror

Year: 2012

Journal: BioMed Central Health Services Research, Vol. 12, p. 23, 2012

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Abstract: Background: This study examines health-related “hardship financing” in order to get better insights on how poor households finance their out-of-pocket healthcare costs. We define hardship financing as having to borrow money with interest or to sell assets to pay out-of-pocket healthcare costs. Methods: Using survey data of 5,383 low-income households in Orissa, one of the poorest states of India, we investigate factors influencing the risk of hardship financing with the use of a logistic regression. Results: Overall, about 25% of…read more

Is RSBY India’s Platform to Implementing Universal Hospital Insurance?

Authors: David M Dror and Sukumar Vellekkal

Year: 2012

Journal: Indian Journal of Medical Research, Vol. 135, pp. 56-63, January 2012

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Abstract: Background & Objective: In 2008, India’s Labour Ministry launched a hospital insurance called Rastriya Swasthya Bima Yojana (RSBY) covering ‘Below-Poverty-Line’ (BPL) households. RSBY is implemented through insurance companies; premiums are subsidized by Union and States governments (75%:25%). We examine RSBY’s enrollment of BPL, costs vs. budgets and policy ramifications. Methods: Numbers of BPL are obtained by following criteria of two committees appointed for this task. District-specific premiums are weighted to obtain national average premiums. Using the BPL estimates and national…read more

The Elusive Quest for Estimates of Willingness to Pay for Health Microinsurance

Authors: David M Dror and Ruth Koren

Year: 2012

Book: Protecting the Poor: A Microinsurance Compendium. Vol II. Edited by C. Churchill and M. Matul. Geneva, ILO, 2012. Chapter 7. pp: 156-173

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Abstract: Focusing on poor people in low-income countries (LICs) entails a price constraint for those planning to supply health insurance. The challenge is to price health insurance at a level that ensures a balance between expenditure and income, at least in the long term, and remains affordable and attractive to poor people. This balance can be achieved either by limiting expenditure to available premium income where membership is usually voluntary – even though the affiliation unit can include more than one…read more

Illness Mapping: A Time and Cost Effective Method to Estimate Healthcare Data Needed to Establish Community-based Health Insurance

Authors: Erika Binnendijk, Meenakshi Gautham, Ruth Koren, David M Dror

Year: 2012

Journal: Journal: BMC Medical Research Methodology 2012, 12:153 doi:10.1186/1471-2288-12-153 Published: 9 October 2012

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Abstract: Background: Most healthcare spending in developing countries is private out-of-pocket. One explanation for low penetration of health insurance is that poorer individuals doubt their ability to enforce insurance contracts. Community-based health insurance schemes (CBHI) are a solution, but launching CBHI requires obtaining accurate local data on morbidity, healthcare utilization and other details to inform package design and pricing. We developed the “Illness Mapping” method (IM) for data collection (faster and cheaper than household surveys). Methods: IM is a modification of…read more

Can the Rural Poor in India Afford to Treat Non-Communicable Diseases?

Authors: Erika Binnendijk, Ruth Koren and David M Dror

Year: 2012

Journal: Tropical Medicine and International Health; September 4, 2012, DOI: 10.1111/j.1365-3156.2012.03070.x

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Abstract: Objective Non-communicable diseases (NCD) are on the increase in low-income countries, where healthcare costs are paid mostly out-of-pocket. We investigate the financial burden of NCD vs. communicable diseases (CD) among rural poor in India and assess whether they can afford to treat NCD. Methods We used data from two household surveys undertaken in 2009 - 2010 among 7389 rural poor households (39,205 individuals) in Odisha and Bihar. All persons from the sampled households, irrespective of age and gender, were included…read more

Transforming Community Health Funds in Tanzania into Viable Social Health Insurance Schemes: The Challenges Ahead

Authors: Manfred Stoermer, Ralf Radermacher and Mackenzie Vanderhyden

Year: 2011

Journal: Medicus Mundi Schweiz, Bulletin 120

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Abstract: Community Health Funds (CHFs) aim to build up a risk pooling mechanism protecting the population, to contribute to improved quality of healthcare, to community empowerment, and to affordable, equitable access to health services for rural population and informal sector communities throughout the year. However, CHFs face a number of problems which so far hamper the achievement of these objectives.read more

Microinsurance – Ensuring Insurance for the Most Vulnerable

Authors: Johannes Brinkmann and Devendra Tak

Year: 2011

Journal: Scandinavian Insurance Quarterly 1/2011

Abstract: Microinsurance is widely recognized as an important tool for economic development. As many low-income people can’t access necessary risk management tools, they are vulnerable to fall into deep poverty in times of hardship, for example when the breadwinner of the family dies, or when high hospital bills force families to take loans on high interest rates. Microinsurance also enables people to take more risks. This article discusses the relative new concept of microinsurance. Read the full article here.read more

Reconciling Research and Implementation in Micro Health Insurance Experiments in India: Study Protocol for a Randomized Control Trial

Authors: Conor Doyle, Pradeep Panda, Ellen Van de Poel, Ralf Radermacher and David M Dror

Year: 2011

Journal: Trials, Vol. 12, No. 224, 2011

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Abstract: Background: Microinsurance or Community-Based Health Insurance is a promising healthcare financing mechanism, which is increasingly applied to aid rural poor persons in low-income countries. Robust empirical evidence on the causal relations between Community-Based Health Insurance and healthcare utilisation, financial protection and other areas is scarce and necessary. This paper contains a discussion of the research design of three Cluster Randomised Controlled Trials in India to measure the impact of Community-Based Health Insurance on several outcomes. Methods/Design: Each trial sets up…read more

Community-based Microinsurance: Innovations on the Education of the Poor to Manage their Risks

Authors: David M Dror

Year: 2011

Journal: Asia Insurance Review, July 2011

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Abstract: Creating awareness for insurance among the poor and educating them to bridge the literacy gap are some of the many activities that Micro Insurance Academy (MIA) is involved in. Dr. David Dror of MIA shares their experiences in Nepal and India and their conviction that low-income communities can handle the functions of insurance.read more

“First We Go To The Small Doctor”: First Contact for Curative Health Care Sought by Rural Communities in Andhra Pradesh and Orissa, India

Authors: Meenakshi Gautham, Erika Binnendijk, Ruth Koren and David M Dror

Year: 2011

Journal: Indian Journal of Medical Research, Vol. 134, No. 11, pp. 627-663, November 2011

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Abstract: Background: Against the backdrop of insufficient public supply of primary care and reports of informal providers, we sought fresh descriptive evidence on 1st contact curative health care seeking choices among rural communities in Andhra-Pradesh (AP) and Orissa. Methods: Our cross sectional study design combined a Household Survey (1,810 households in AP; 5,342 in Orissa), 48 Focus Group Discussions (19 in AP; 29 in Orissa), and 61 Key Informant Interviews with healthcare providers (22 in AP; 39 in Orissa). Results: In…read more

Can We Assume That People Understand Insurance Principles?

Authors: David M Dror

Year: 2011

Journal: Medicus Mundi Switzerland (MMS), Vol. 120, pp. 50-54, June 2011

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Abstract: When approaching people at the "base of the pyramid" (BOP) in low-income countries (LIC) with the idea of insurance, the first challenge is to establish a basis for communication. The question that arises is whether they understand insurance principles. We examined this issue by analyzing  replies to a series of questions in household surveys we conducted in several locations in India and Nepal.read more

A Landscape Study of Micro Insurance Education

Authors: Iddo Dror, Kathleen Jenkins, Keiju Motegi and Juho Siltanen

Year: 2011

Journal: Micro Insurance Academy, ISBN: 978-81-909841-4-0, pp.1-98, June 2011

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Abstract: The landscape study takes stock of what insurance education materials are currently available, identifies existing gaps, and highlights areas where investment can make a positive impact on the extension of microinsurance. The study findings are based on over 240 survey respondents from 65 countries as well as 109 interviews with organizations from 49 countries.read more

Integrated Risk Management in Microinsurance

Authors: Ralf Radermacher, Jacquiline Roberts Singh and Siddharth Srivastava

Year: 2010

Journal: Global Risk Forum GRF Davos

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Abstract: Microinsurance can be a tool in Disaster Risk Reduction/Management - but only if it survives the disaster itself. Reinsurance can help microinsurance to survive disasters. However, reinsurers regard the microinsurance entity as a risky client and are hesitant to engage in this market. An Integrated Risk Management approach can help a microinsurer to become a better client for reinsurance and thus to obtain reinsurance cheaper - or obtain it at all. However, Integrated Risk Management for microinsurance is insufficiently conceptualized so far.…read more

Financial Inclusion Opportunities for Micro Health Insurance in Nepal

Authors: Siddharth Srivastava, Atanu Majumdar and Jacquiline Roberts Singh

Year: 2010

Abstract: This report is based on information collected in two districts of Nepal (Banke and Dhading) in early 2009 and concerns the launch of community-based micro health insurance units for members of Nirdhan and DEPROSC, two grassroots microfinance NGOs. The study entailed a household survey of 2,008 households, 40 focus group discussions (with potential beneficiaries), in addition to 51 key informant interviews with healthcare providers. The purpose of the study was to collect the data needed for designing and pricing an…read more

Community-based Microinsurance: Localized and Responsive

Authors: Ralf Radermacher and Iddo Dror

Year: 2010

Journal: Rural 21 - The International Journal for Rural Development – 04/2010

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Abstract: The supply of microinsurance through insurance companies or government programmes is often still limited or not matching local requirements. Community-based insurance schemes fill gaps and offer a potential to link up with the "formal" sector.read more

Microinsurance: Innovations in Low-Cost Health Insurance

Authors: David M Dror, Ralf Radermacher, Shrikant B. Khadilkar, Petra Schout, Francois-Xavier Hay, Arbind Singh and Ruth Koren

Year: 2009

Journal: Health Affairs, Vol. 28, No. 6, pp. 1788-1798

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Abstract: Microinsurance—low-cost health insurance based on a community, cooperative, or mutual and self-help arrangements—can provide financial protection for poor households and improve access to health care. However, low benefit caps and a low share of premiums paid as benefits—both designed to keep these arrangements in business— perversely limited these schemes’ ability to extend coverage, offer financial protection, and retain members. We studied three schemes in India, two of which are member-operated and one a commercial scheme, using household surveys of insured…read more

Incidence of Illness among Resource-Poor Households: Evidence from Five Locations in India

Authors: David M Dror, Olga van Putten-Rademaker and Ruth Koren

Year: 2009

Journal: Indian Journal for Medical Research (New Delhi), Vol. 130, pp. 146-154, August 2009

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Abstract: Background & Objectives: This study examines the association between household attributes and perceived morbidity within resource-poor house holds (HHs) in India at five locations. This presents an innovation compared to most epidemiological studies, which focus on associations between the incidence of an illness and characteristics of the ill person. Methods: Perceived morbidity was represented by a variable called “Incidence of illness in a HH” (IIH) = the number of self reported illness episodes during three months preceding the survey, divided…read more

Bad Luck v.s. Self-Inflicted Neediness – An Experimental Investigation of Gift Giving in a Solidarity Game

Authors: Nadja Trhal and Ralf Radermacher

Year: 2009

Journal: Journal of Economic Psychology, Vol. 30

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Abstract: We experimentally examine the impact of self-inflicted neediness on the solidarity behavior of subjects. In one treatment in our solidarity experiment all subjects face the same probability of becoming needy, in the other treatment subjects have the choice between a secure payment and a lottery which includes a certain probability of becoming needy. Then all subjects are asked how much they will give to losers in their group to investigate if people are willing to give the same gifts whether…read more

Micro Health Insurance: The Quest for a Balance Between Different Interests of Healthcare Providers, Clients and Insurers

Authors: David M Dror

Year: 2008

Journal: Health Action, Vol. 28, No. 5, pp. 10-12, April 2008

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Abstract: The three partners in the equation of health insurance are the clients, the providers of care and the insurers. Each of the stakeholders aims at different objectives: providers of healthcare seek to deliver health services, and each provider focuses on those services that it has the capacity to deliver. The objective of insurers is to ensure that expenditure levels will not exceed the income. And the objective of clients is to obtain affordable and good quality services that are relevant…read more

Cost of Illness: Evidence from a Study in Five Resource-Poor Locations in India

Authors: David M Dror, Olga van Putten-Rademaker and Ruth Koren

Year: 2008

Journal: Indian Journal for Medical Research (New Delhi), Vol. 127, pp. 343-357, April 2008

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Abstract: Background & Objectives: In India, health services are funded largely through out-of-pocket spendings (OOPS). We carried out this study to collect data on the cost of an illness episode and parameters affecting cost in five locations in India. Methods: The data were obtained through a household survey carried out in 2005 in five locations among resource-poor persons in rural India. The analysis was based on self-reported illness episodes and their costs. The study was based on 3,531 households (representing 17,323…read more

Health Insurance at 2 Euro Per Year?

Authors: David M Dror

Year: 2008

Journal: Viewpoints 2008: Building Change Communities, pp. 72-78, March 2008

Abstract: Today, after Prof. Yunus debunked the myth that the poor are unbankable, microfinance is on everyone's lips. Yet, most insurers and investors still say that the poor are uninsurable. Is this fact or fable? In this short article we explain the vicious cycle that causes the mismatch between demand for and supply of health insurance in India. We also propose ways to break this vicious cycle, and offer reasons why health insurance at as little as 2 Euro per year…read more

Community Based Micro Health Insurance as an Enabler of Solidarity and Self-Help amongst Poor Communities

Authors: Iddo Dror

Year: 2008

Journal: Microfinance Focus, Vol. 2, Issue 8, September 2008

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Abstract: In a country where less than 3% of the population has access to insurance, and where upwards of 35 million people fall below the poverty line each year because of a single health event in the family, it is slowly being accepted that “micro health insurance units” (MIUs) that offer benefit packages and require pre-payment create a rudimentary insurance among marginalized and underserved segments of the population in India. MIUs represent a high hope for extension of health insurance coverage…read more

A Socio-Economic Profile of the Micro (Health) Insurance Target Population

Authors: David M Dror

Year: 2008

Journal: Asian Insurance Review, pp. 80-81, December 2008

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Abstract: A snapshot review of the Pulse of a Silently Transforming India: A 2005 EU-India Economic Cross Cultural Programme (ECCP) Household survey reveals that the target population for microinsurance schemes attached importance on education and they seek the best in healthcare. Professor David M Dror, Founder-Chairman at Micro Insurance Academy, New Delhi and Hon Professor of Health Insurance at the Erasmus University, Rotterdam (Netherlands), examines the results of this survey, giving insights into this segment’s changing needs and how microinsurance schemes…read more

Social Capital and Microinsurance – Insights from Field Evidence in India

Authors: Iddo Dror

Year: 2007

Journal: Microfinance Insights Vol. 5

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Abstract: The link between social capital and microfinance activity gained considerable mainstreaming when Prof. M. Yunus and the Grameen Bank he founded won the Nobel Peace Prize in 2006. But what are the repercussions for microinsurance? This article sheds light on grassroots’ perception of insurance from a social capital perspective through new evidence from a household survey carried out in India.read more

Micro Health Insurance in India – Pointers for Progress

Authors: David M Dror

Year: 2007

Journal: IRDA Journal, Vol. 5, No. 12, 2007

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Abstract: One cannot exclude the possibility that insurers and others, insufficiently aware of clients' priorities, seem to misinterpret low demand as reflecting low willingness to pay, ignoring the unattractive value proposition of the main product and the devastating impact on the demand side of cherry picking. One can wonder if those who are interested in making insurance work for the poor in India might be stuck in a vicious cycle, which looks like this: poor products - low demand - low…read more

Health Insurance Benefit Packages Prioritized by Low-Income Clients in India: Three Criteria to Estimate Effectiveness of Choice

Authors: David M Dror, Ruth Koren, Alexander Ost, Erika Binnendijk, Sukumar Vellakkal and Marion Danis

Year: 2007

Journal: Social Science & Medicine, Vol. 64, No. 4, 2007

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Abstract: We applied a decision tool for rationing choices, with a predetermined budget of about US$11 per household per year, to identify priorities of poor people regarding health insurance benefits in India in late 2005. A total of 302 individuals, organized in 24 groups, participated from a number of villages and neighborhoods of towns in Karnataka and Maharashtra. Many individuals were illiterate, innumerate and without insurance experience. Involving clients in insurance package design is based on an implied assumption that people…read more

Eliciting Health Insurance Benefit Choices of Low Income Groups

Authors: Marion Danis, Erika Binnendijk, Sukumar Vellakkal, Alexander Ost, Ruth Koren and David M Dror

Year: 2007

Journal: Economic and Political Weekly (Mumbai), Vol. 42, No. 32, pp. 3331-3339, August 11-17, 2007

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Abstract: An appropriate scheme of health insurance must respond to clients’ priorities, yet cover a finite and affordable benefit package. A variety of methods have been developed so far to engage the public in prioritising services. This paper deals with a plan that allows variably educated populations who are inexperienced with health insurance to pick health benefits. The decision exercise reported here enhances popular understanding (1) that even within a limited premium there is a choice of different package compositions; and…read more

Demystifying Micro Health Insurance – Choosing Health Plans All Together (CHAT)

Authors: Iddo Dror

Year: 2007

Journal: Microfinance Insights, Vol. 4, pp.17-19, September 2007

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Abstract: This article examines the utilization of a simulation exercise known as Choosing All Health Insurance (CHAT). As a decision tool, this exercise allows variably educated resource-poor populations who are inexperienced with health insurance to select health benefits that they perceive to be relevant. CHAT was adapted to developmental context of India through the project Strengthening Micro Health Insurance Units for the Poor (2005-2006). The primary beneficiaries of this exercise were poor communities at the bottom of the pyramid given that…read more

Why “One-Size-Fits-All” Health Insurance Products are Unsuitable For Low-income Persons in the Informal Economy in India

Authors: David M Dror

Year: 2007

Journal: Asian Economic Review, Vol. 49, No. 1, 2007

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Abstract: Limited funding dictates that health insurance for low-income persons would compensate only part of healthcare needs. Existing health insurance products in India are too restrictive to be attractive to low-income & rural populations. We hypothesize that attractive health insurance must represent an optimum match between clients’ needs for health care, demand for health insurance, and available supply of health care. Based on data from a household survey among rural poor and urban slum dwellers in seven locations in India collected…read more

Willingness to Pay for Health Insurance among Rural and Poor Persons: Field Evidence from Seven Micro Health Insurance Units in India

Authors: David M Dror, Ralf Radermacher and Ruth Koren

Year: 2007

Journal: Health Policy, Vol. 82, No. 1, 2007

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Abstract: This study, conducted in India in 2005, provides evidence on Willingness to pay (WTP), gathered through a unidirectional (descending) bidding game among 3024 households (HH) in seven locations where micro health insurance units are in operation. Insured persons reported slightly higher WTP values than uninsured. About two-thirds of the sample agreed to pay at least 1%; about half the sample was willing to pay at least 1.35%; 30% was willing to pay about 2.0% of annual HH income as health…read more

Health Insurance for the Poor: Myths and Realities

Authors: David M Dror

Year: 2006

Journal: Economic and Political Weekly (Mumbai), Vol. 41, No. 43-44

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Abstract: Based on a survey in seven locations, this article finds that most Indians are willing to pay 1.35 per cent of income or more for health insurance and most people prefer a holistic benefit package at basic coverage over high coverage of only rare events. The needs of the poor, and their demand for health insurance, depend on local conditions.read more

The Impact of Filipino Micro Health Insurance Units on Income-Related Equality of Access to Healthcare

Authors: David M Dror, Ruth Koren and David Mark Steinberg

Year: 2006

Journal: Health Policy, Vol. 77, No. 3, 304 - 317

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Abstract: Background: This study aims to assess the impact of being insured by micro-health insurance units (MIUs) on equality of access to health care among groups with inequitable income distribution. We measure equality by relating income with access to healthcare. The analysis is based on a household survey conducted in five regions in the Philippines in 2002. Methods: We generated concentration curves and indices (CI) for insured and uninsured households (150 for each cohort in each region). We also elaborated a…read more

Challenges and Strategies to Extend Health Insurance to the Poor

Authors: Ralf Radermacher, Iddo Dror and Gerry Noble

Year: 2006

Book: PROTECTING THE POOR - A MICROINSURANCE COMPENDIUM, Churchill C., ed., Munich Re Foundation/ILO, 2006, pp 66-93

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Abstract: Health insurance has several peculiarities that distinguish it from other types of coverage, such as life and property. This chapter reviews the specific characteristics of health microinsurance, paying special attention to the different points of view of insurance providers and the insured. Talking about health microinsurance requires, firstly, agreement on the definition. This chapter defines health insurance as a risk-transfer mechanism under which the insurer assumes a certain risk on behalf of the insured in exchange for a premium. The…read more

Institutional Options for Delivering Health Microinsurance

Authors: Ralf Radermacher and Iddo Dror

Year: 2006

Book: Chapter 4.4 in Churchill C. (ed.): “Protecting the Poor: A Microinsurance Compendium”

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Abstract: Health insurance entails the transfer of health risks in return for a premium payable in advance. This succinct description suggests that the arrangement entails flows of funds and information in two directions: from the client to the insurer and from the insurer to the client. The party with the most control of these flows of funds and information can influence the business process to its advantage. This notion that one party would seek an advantage over another implies that conflicts…read more

The Role of Insurers and Reinsurers in Supporting Insurance for the Poor

Authors: David M Dror and Thomas Wiechers

Year: 2006

Book: Chapter 5.4 in Churchill C. (ed.): "Protecting the Poor: A Microinsurance Compendium", Geneva, ILO, pp. 524-544, 2006

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Abstract: In his address to the Microinsurance Conference sponsored by the Munich Re Foundation in October 2005, Hans-Jürgen Schinzler1 offered his perspective on why commercial insurers and reinsurers were infrequent players in the low-income market: “Premium income is low, administrative costs are relatively high, and infrastructure for insurance is lacking; that’s why commercial insurers have not taken more interest in this market.” This candid statement suggests that if premium income were high and administrative costs were relatively low, and the infrastructure…read more

Do Micro Health Insurance Units Need Capital or Reinsurance? A Simulated Exercise to Examine Different Alternatives

Authors: David M Dror and John Armstrong

Year: 2006

Journal: The Geneva Papers on Risk and Insurance - Issues and Practice, Vol. 31, No. 4, 2006

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Abstract: The purpose of this article is to provide a technical discussion of capital loading that ‘‘micro health insurance units’’ (MIUs) must add to the premium to maintain financial sustainability. MIUs offer benefit packages and require prepayment, that is, they create a rudimentary community-based health insurance for poor people in low-income countries. We broke up the 2001 data set of a health insurer containing upward of 1.3 million insureds into 535 ‘‘virtual MIUs’’; and running 1,005 iterations, we got a data…read more

Reinsurance and Other Facilities for the Indian Micro Health Insurance System

Authors: David M Dror

Year: 2006

Journal: FORTE Insurance Journal, Special Issue on Micro Insurance

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Abstract: It is increasingly recognized that the economic cost of a risk is greater to the insured than to the insurer, and therefore the transfer of risk can create value for the insured poor. But is there is sufficient opportunity for the poor to transfer risks to insurers? This article identifies some components that could contribute in making this possible. The article discusses the importance of ensuring a fair premium; the cost of reserve capital (capital loading); the cost of administration…read more

Why Micro Health Insurance Units Cannot Forego Reinsurance

Authors: David M Dror, John Armstrong and Vijay Kalavakonda

Year: 2005

Journal: Journal of Insurance and Risk Management (special issue on micro health insurance), Vol. 4, No. 7, 2005

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Abstract: Micro health insurance units (MIUs) reduce negative financial consequences of healthcare costs for people who cannot access to formal and affordable health insurance. In order to survive, MIUs need capital to cover their outlier costs (whose probability of occurring is low but not zero). The first purpose of this study is to estimate the capital that MIUs require to secure their financial viability as stand-alone risk carriers. The second objective is to consider the cost/benefit of reinsurance as an alternative…read more

Dealing with Adversity Through Diversity

Authors: David M Dror

Year: 2006

Journal: Pravartak Special Issue on Insurance and Disaster Management

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Abstract: This opinion piece offers a review of three kinds of disasters: natural, political and health events. With examples from all three types of disasters, the author submits that even though disasters of all types are increasing in frequency and severity, health risks are those that expose single individuals and households to more adversity and a higher likelihood of catastrophic consequences than other disasters. A short review of measures employed in a number of countries points that the common denominator is that…read more

Integrating Health Insurance for the Poor into the Indian Insurance Scenario

Authors: David M Dror and Ralf Radermacher

Year: 2005

Journal: Insurance Watch, Vol. 3, No. 12

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Abstract: The financial consequence of illness is a major risk for any household. For many poor households and for the Indian society as a whole, exposure to this risk is comparable to major catastrophes like Asia's Tsunami. The discussion surrounding how to respond to the tsunami disaster focused largely on what government could do through relief programs and early warning systems, with amazingly little attention to what insurance could have done to mitigate risks and reduce personal destitution. Similar focus is…read more

Field Based Evidence of Enhanced Healthcare Utilization Among Persons Insured by Micro Health Insurance Units in Philippines

Authors: David M Dror, Elmer S Soriano, Marilyn E Lorenzo, Jesus N Sarol Jr, Rosebelle S Azcuna and Ruth Koren

Year: 2005

Journal: Health Policy, Vol. 73, No. 3, 2005

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Abstract: Underutilization of healthcare is common among rural and low-income population segments in countries with lower income or inequitable income distribution. Micro health insurance units (MIUs) are created by informal sector groups because people cannot access health insurance or are dissatisfied with the programmes they can access. The policy choice to support MIUs relies on evidence that affiliation with these schemes increases healthcare utilization. This article examines new evidence of the association between affiliation with MIUs and healthcare utilization. We analyzed…read more

Yeshasvini Trust, Karnataka India

Authors: Ralf Radermacher, Natasha Wig, Olga van Putten-Rademaker, Verena Muller, and David M Dror

Year: 2005

Journal: CGAP Working Group on Microinsurance: Good and Bad Practices, Case Study No. 20, 2005

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Abstract: The Yeshasvini Cooperative Farmers Health Scheme is a young but incredibly successful micro-insurance scheme in Karnataka. Having started in 2003 with 1.6 million insured right away, it covered 2.2 million lives in its second year of operation, but in the third year it dropped to 1.45 million members after doubling the premium. This (still) amazing success is possible through a tight partnership with the cooperative sector enabled through the Karnataka Department of Cooperation. The department used its influence to encourage…read more

Rich-Poor Differences in Health Care Financing

Authors: Alexander S Preker, Guy Carrin, David M Dror, Melitta Jakab, William C Hsiao and Dyna Arhin-Tenkorang

Year: 2004

Book: HEALTH FINANCING FOR POOR PEOPLE: RESOURCE MOBILIZATION AND RISK SHARING, Preker A.S., Carrin G., eds., pp. 3-51, World Bank, 2004

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Abstract: Most community finance schemes have evolved in the context of severe economic constraints, political instability, and lack of good governance. Usually government taxation capacity is weak, formal mechanisms of social protection for vulnerable populations absent, and government oversight of the informal health sector lacking. In this context of extreme public sector failure, community involvement in financing health care provides a critical, though insufficient, first step in the long march toward improved health care access for the poor and social protection…read more

Social ReInsurance: A New Approach to Sustainable Community Health Financing

Authors: David M Dror and Alexander S Preker

Year: 2002

Book: SOCIAL REINSURANCE: A NEW APPROACH TO SUSTAINABLE COMMUNITY HEALTH FINANCING, Dror DM, Preker AS, eds., World Bank & ILO, 2002

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Abstract: This volume treats community-based microinsurance as an incremental first step to improved financial protection and access to health services for poor, rural, and informal-sector workers. It challenges the ability of low- and middle-income countries to leapfrog the long developmental process needed to build among excluded population segments the trust in central government-run schemes that could extend coverage to the whole population as a big-bang top-down endeavor. In the meantime, governments could introduce more pro-poor policies that would build on existing…read more

A Model of Microinsurance and Reinsurance

Authors: Stephane Bonnevay, David M Dror, Gerard Duru and Michel Lamure

Year: 2002

Book: SOCIAL REINSURANCE: A NEW APPROACH TO SUSTAINABLE COMMUNITY HEALTH FINANCING, Dror D.M., Preker A.S., eds., pp. 153-186, World Bank & ILO, 2002

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Abstract: Reinsurance offers insurance companies many advantages, including stabilization of losses and surplus enhancement, according to Outreville (chapter 3, this volume). Can reinsurance therefore ensure the financial stabilization of multiple microinsurance units? This question can be approached in two ways: empirically or theoretically. The empirical approach consists of carrying out repeated field studies in real-life settings and observing the results. However, since there are no field data on reinsurance transactions with microinsurers, whether reinsurance can work for small health schemes needs…read more

Attitudes Toward Solidarity, Risk, and Insurance in the Rural Philippines

Authors: Elmer S Soriano, M.D., David M Dror, Erwin Alampay and Yolanda Bayugo

Year: 2002

Book: SOCIAL REINSURANCE: A NEW APPROACH TO SUSTAINABLE COMMUNITY HEALTH FINANCING, Dror DM, Preker AS, eds., World Bank & ILO, 2002

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Abstract: A sustainable health reinsurance system can be fashioned for the informal sector by mobilizing social and economic forces operating within individual communities. The economic analysis in part 1 of this book draws conclusions from success stories in industrial countries and failures in low- and medium-income countries. This analysis leads to the premise that decentralized development of microinsurance units, operating in a market segment left out by for-profit health insurance firms and by national schemes, can be stabilized financially through their…read more

Data Template: A Framework for Accounting and Statistics

Authors: David M Dror and Rakesh Rathi

Year: 2002

Book: SOCIAL REINSURANCE: A NEW APPROACH TO SUSTAINABLE COMMUNITY HEALTH FINANCING, Dror DM, Preker AS, eds., pp. 447-458, World Bank & ILO, 2002

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Abstract: This manual explains how to use the Social Re Data Template (v. 1.0) software. It explains the purpose of all the data forms and gives advice on operating the system.read more

Effectiveness of Community Health Financing in Meeting the Cost of Illness

Authors: Alexander Preker, Guy Carrin, David M Dror, Melitta Jakab, William Hsiao and Dyna Arhin

Year: 2002

Journal: Bulletin of the World Health Organization, Vol. 80, No. 2

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Abstract: How to finance and provide health care for the more than 1.3 billion rural poor and informal sector workers in low- and middle-income countries is one of the greatest challenges facing the international development community. This article presents the main findings from an extensive survey of the literature of community financing arrangements, and selected experiences from the Asia and Africa regions. Most community financing schemes have evolved in the context of severe economic constraints, political instability, and lack of good…read more

Health Insurance and Reinsurance at the Community Level

Authors: David M Dror

Year: 2002

Book: SOCIAL REINSURANCE: A NEW APPROACH TO SUSTAINABLE COMMUNITY HEALTH FINANCING, Dror DM, Preker AS, eds., pp. 103-124, World Bank & ILO, 2002

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Abstract: Microfinance institutions have acquired experience operating certain types of insurance (Balkenhol and Churchill, chapter 4, this volume). Often, microfinance lenders sell life or crop insurance as security for loans in lieu of traditional collateral. Such an arrangement, making the lender both beneficiary and insurer, protects the lender instead of the insured. The basic difference between this type of insurance and health insurance is in the definition of beneficiary or principal. Because health insurance is not a necessary condition for access…read more

Health Insurance for the Poor Through Community Schemes

Authors: David M Dror

Year: 2002

Book: Defining an agenda for poverty reduction: proceedings of the first Asia and Pacific forum on poverty, Vol. 2, pp. 217-234, Asian Development Bank, 2002

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Abstract: The main insight gained from this study is that community-based health schemes can be helped to function as micro health insurance units (MIUs), which can reduce the exposure of poor population segments, living and working in the informal economy and the rural sector, to health-related financial risk. However, MIUs cannot succeed if they operate as isolated entities. Their efficiency and survival can be greatly improved by pooling the risks of many such schemes. Furthermore, pooling poor schemes only with other…read more

Minimum Accounting and Statistics Framework

Authors: David M Dror

Year: 2002

Book: SOCIAL REINSURANCE: A NEW APPROACH TO SUSTAINABLE COMMUNITY HEALTH FINANCING, Dror DM, Preker AS, eds., pp. 313-326, World Bank & ILO, 2002

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Abstract: Microinsurers exercise several roles, all of them requiring data.' The focus here is on the data necessary in the relationship between reinsurer and microinsurer. In this context, the main purpose of a statistical and accounting framework is to provide the data required to operate the reinsurance model. This chapter defines this cluster of data. The framework also provides microinsurers with the information they need to fulfill their other roles.read more

The Role of Communities in Combating Social Exclusion

Authors: David M Dror, Alexander Preker and Melitta Jakab

Year: 2002

Book: SOCIAL REINSURANCE: A NEW APPROACH TO SUSTAINABLE COMMUNITY HEALTH FINANCING, Dror DM, Preker AS, eds., pp. 37-56, World Bank & ILO, 2002

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Abstract: The link between employment and health insurance has been central to the extension of coverage to entire populations in most industrial countries where urbanization and formal labor-market participation are high. This link is more difficult-if not impossible-to forge in the case of rural, agricultural, or self-employed workers or the urban poor who have neither formal employers nor steady work. These groups make up most of the population in most low- and middle-income countries. For these excluded populations, access to health…read more

To Insure or Not to Insure? Reflections on the Limits of Insurability

Authors: Michel Vate and David M Dror

Year: 2002

Book: SOCIAL REINSURANCE: A NEW APPROACH TO SUSTAINABLE COMMUNITY HEALTH FINANCING, Dror DM, Preker AS, eds., pp. 125-152, World Bank & ILO, 2002

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Abstract: How can social reinsurance sustain community health financing when governments cannot fund universal coverage? The answer to this question is the overriding focus of this book. Appropriate insurance is one option (Musgrove 1999, p. 55), but what kind of insurance is appropriate? The realm of insurance is ever-changing. When new risks are identified-or as new forms of risk transfer are formulated for known risks-the question about the limits of insurability comes up again and again. In the ordinary framework of…read more

Health Care Financing for Rural and Low-Income Populations: The Role of Communities in Resource Mobilization and Risk Sharing

Authors: Alexander S Preker, Guy Carrin, David M Dror, Melitta Jakab, William Hsiao, Dyna Arhin-Tenkorang

Year: 2001

Journal: CMH Working Paper No. WG3:4

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Abstract: A synthesis background report to Commission on Macroeconomics and Health.read more

Reinsurance of Health Insurance for the Informal Sector

Authors: David M Dror

Year: 2001

Journal: Bulletin of the World Health Organization, Vol. 79, No. 7

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Abstract: Deficient financing of health services in low-income countries and the absence of universal insurance coverage leaves most of the informal sector in medical indigence, because people cannot assume the financial consequences of illness. The role of communities in solving this problem has been recognized, and many initiatives are under way. However, community financing is rarely structured as health insurance. Communities that pool risks (or offer insurance) have been described as micro-insurance units. The sources of their financial instability and the…read more

Analysis of a New Concept: Microinsurance, to Close the Gap of Bilateral Health Interventions

Authors: David M Dror, Robert Fonteneau and Christian Jacquier

Year: 2001

Journal: Journal d'Economie Médicale, Vol. 19, No. 3, 2001

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Abstract: This paper proposes a way to improve health provision for populations that are usually excluded from access to health services. It starts out from a short description of who the excluded are, and what they are excluded from. The paper then looks at the major policy statements elaborated at the international level, and proceeds to propose the missing dimension. Next, based on field-testing and analysis of several tens of pilot cases, the paper proposes a concept for group-based health insurance,…read more

What is at Stake with Cooperation to Enhance Healthcare? (Helping Those Who Help Themselves)

Authors: Robert Fonteneau and David M Dror

Year: 2001

Journal: Journal d'Economie Médicale, Vol. 19, No. 4, 2001

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Abstract: From various national or international sources, this paper is an attempt to do a check up on social exclusion in French-speaking countries relatively to the health condition. In the same time it is a diagnosis about the lack of health covering and the reasons of that situation. The present state is described by testing a classification of usual different schemes existing in health systems which anywhere are split in state, mandated, mutual, corporate or free market schemes; these ones are…read more

Reforming Health Insurance: A Question of Principles?

Authors: David M Dror

Year: 2000

Journal: International Social Security Review, Vol. 53, No. 2

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Abstract: Most industrialized countries have financed health services through health insurance. Two systems prevail: private, or public (social) health insurance. The theoretical differences between them are reviewed. It is argued that most health systems are, however, hybrids and that health insurance reform in Europe and the United States has accentuated this trend because the principles distinguishing the two systems have often been ignored. This is illustrated through the evolution of voluntary vs. compulsory affiliation, coping with moral hazard, and provider regulation.read more

Micro Insurance: Extending Health Insurance to the Excluded

Authors: David M Dror and Christian Jacquier

Year: 1999

Journal: International Social Security Review, Vol. 52, No. 1, January-March 1999

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Abstract: This paper proposes a way to improve health provision for populations that are usually excluded from access to health services. It starts out with a short description of who the excluded are, and what they are excluded from. The paper then looks at the major policy statements elaborated at the international level, and proceeds to propose the missing dimension. Next, based on field testing and analysis of several tens of pilot cases, the paper proposes a concept for group-based health…read more