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Adverse selection in a community-based health insurance scheme in rural Africa: Implications for introducing targeted subsidies
BACKGROUND: Although most community-based health insurance (CBHI) schemes are voluntary, problem of adverse selection is hardly studied. Evidence on the impact of targeted subsidies on adverse selection is completely missing. This paper investigates adverse selection in a CBHI scheme in Burkina Faso...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2012
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3457900/ https://www.ncbi.nlm.nih.gov/pubmed/22741549 http://dx.doi.org/10.1186/1472-6963-12-181 |
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author | Parmar, Divya Souares, Aurélia de Allegri, Manuela Savadogo, Germain Sauerborn, Rainer |
author_facet | Parmar, Divya Souares, Aurélia de Allegri, Manuela Savadogo, Germain Sauerborn, Rainer |
author_sort | Parmar, Divya |
collection | PubMed |
description | BACKGROUND: Although most community-based health insurance (CBHI) schemes are voluntary, problem of adverse selection is hardly studied. Evidence on the impact of targeted subsidies on adverse selection is completely missing. This paper investigates adverse selection in a CBHI scheme in Burkina Faso. First, we studied the change in adverse selection over a period of 4 years. Second, we studied the effect of targeted subsidies on adverse selection. METHODS: The study area, covering 41 villages and 1 town, was divided into 33 clusters and CBHI was randomly offered to these clusters during 2004–06. In 2007, premium subsidies were offered to the poor households. The data was collected by a household panel survey 2004–2007 from randomly selected households in these 33 clusters (n = 6795). We applied fixed effect models. RESULTS: We found weak evidence of adverse selection before the implementation of subsidies. Adverse selection significantly increased the next year and targeted subsidies largely explained this increase. CONCLUSIONS: Adverse selection is an important concern for any voluntary health insurance scheme. Targeted subsidies are often used as a tool to pursue the vision of universal coverage. At the same time targeted subsidies are also associated with increased adverse selection as found in this study. Therefore, it’s essential that targeted subsidies for poor (or other high-risk groups) must be accompanied with a sound plan to bridge the financial gap due to adverse selection so that these schemes can continue to serve these populations. |
format | Online Article Text |
id | pubmed-3457900 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2012 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-34579002012-09-26 Adverse selection in a community-based health insurance scheme in rural Africa: Implications for introducing targeted subsidies Parmar, Divya Souares, Aurélia de Allegri, Manuela Savadogo, Germain Sauerborn, Rainer BMC Health Serv Res Research Article BACKGROUND: Although most community-based health insurance (CBHI) schemes are voluntary, problem of adverse selection is hardly studied. Evidence on the impact of targeted subsidies on adverse selection is completely missing. This paper investigates adverse selection in a CBHI scheme in Burkina Faso. First, we studied the change in adverse selection over a period of 4 years. Second, we studied the effect of targeted subsidies on adverse selection. METHODS: The study area, covering 41 villages and 1 town, was divided into 33 clusters and CBHI was randomly offered to these clusters during 2004–06. In 2007, premium subsidies were offered to the poor households. The data was collected by a household panel survey 2004–2007 from randomly selected households in these 33 clusters (n = 6795). We applied fixed effect models. RESULTS: We found weak evidence of adverse selection before the implementation of subsidies. Adverse selection significantly increased the next year and targeted subsidies largely explained this increase. CONCLUSIONS: Adverse selection is an important concern for any voluntary health insurance scheme. Targeted subsidies are often used as a tool to pursue the vision of universal coverage. At the same time targeted subsidies are also associated with increased adverse selection as found in this study. Therefore, it’s essential that targeted subsidies for poor (or other high-risk groups) must be accompanied with a sound plan to bridge the financial gap due to adverse selection so that these schemes can continue to serve these populations. BioMed Central 2012-06-28 /pmc/articles/PMC3457900/ /pubmed/22741549 http://dx.doi.org/10.1186/1472-6963-12-181 Text en Copyright ©2012 Parmar et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Research Article Parmar, Divya Souares, Aurélia de Allegri, Manuela Savadogo, Germain Sauerborn, Rainer Adverse selection in a community-based health insurance scheme in rural Africa: Implications for introducing targeted subsidies |
title | Adverse selection in a community-based health insurance scheme in rural Africa: Implications for introducing targeted subsidies |
title_full | Adverse selection in a community-based health insurance scheme in rural Africa: Implications for introducing targeted subsidies |
title_fullStr | Adverse selection in a community-based health insurance scheme in rural Africa: Implications for introducing targeted subsidies |
title_full_unstemmed | Adverse selection in a community-based health insurance scheme in rural Africa: Implications for introducing targeted subsidies |
title_short | Adverse selection in a community-based health insurance scheme in rural Africa: Implications for introducing targeted subsidies |
title_sort | adverse selection in a community-based health insurance scheme in rural africa: implications for introducing targeted subsidies |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3457900/ https://www.ncbi.nlm.nih.gov/pubmed/22741549 http://dx.doi.org/10.1186/1472-6963-12-181 |
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