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Costes, equidad, eficiencia y viabilidad de identificar a los pobres dentro del esquema nacional de seguro médico de Ghana: análisis empírico de cuatro estrategias
Author(s) -
Aryeetey Genevieve Cecilia,
JehuAppiah Caroline,
Spaan Ernst,
Agyepong Irene,
Baltussen Rob
Publication year - 2012
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1111/j.1365-3156.2011.02886.x
Subject(s) - poverty , equity (law) , business , proxy (statistics) , rural area , public economics , actuarial science , economics , economic growth , medicine , pathology , machine learning , political science , computer science , law
Objectives To analyse the costs and evaluate the equity, efficiency and feasibility of four strategies to identify poor households for premium exemptions in Ghana’s National Health Insurance Scheme (NHIS): means testing (MT), proxy means testing (PMT), participatory wealth ranking (PWR) and geographic targeting (GT) in urban, rural and semi‐urban settings in Ghana. Methods We conducted the study in 145–147 households per setting with MT as our gold standard strategy. We estimated total costs that included costs of household surveys and cost of premiums paid to the poor, efficiency (cost per poor person identified), equity (number of true poor excluded) and the administrative feasibility of implementation. Results The cost of exempting one poor individual ranged from US$15.87 to US$95.44; exclusion of the poor ranged between 0% and 73%. MT was most efficient and equitable in rural and urban settings with low‐poverty incidence; GT was efficient and equitable in the semi‐urban setting with high‐poverty incidence. PMT and PWR were less equitable and inefficient although feasible in some settings. Conclusion We recommend MT as optimal strategy in low‐poverty urban and rural settings and GT as optimal strategy in high‐poverty semi‐urban setting. The study is relevant to other social and developmental programmes that require identification and exemptions of the poor in low‐income countries.