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Efficiency, equity and feasibility of strategies to identify the poor: An application to premium exemptions under National Health Insurance in Ghana

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  • Jehu-Appiah, Caroline
  • Aryeetey, Genevieve
  • Spaan, Ernst
  • Agyepong, Irene
  • Baltussen, Rob

Abstract

Objectives This paper outlines the potential strategies to identify the poor, and assesses their feasibility, efficiency and equity. Analyses are illustrated for the case of premium exemptions under National Health Insurance (NHI) in Ghana.Methods A literature search in Medline search was performed to identify strategies to identify the poor. Models were developed including information on demography and poverty, and costs and errors of in- and exclusion of these strategies in two regions in Ghana.Results Proxy means testing (PMT), participatory welfare ranking (PWR), and geographic targeting (GT) are potentially useful strategies to identify the poor, and vary in terms of their efficiency, equity and feasibility. Costs to exempt one poor individual range between US$11.63 and US$66.67, and strategies may exclude up to 25% of the poor. Feasibility of strategies is dependent on their aptness in rural/urban settings, and administrative capacity to implement. A decision framework summarizes the above information to guide policy making.Conclusions We recommend PMT as an optimal strategy in relative low poverty incidence urbanized settings, PWR as an optimal strategy in relative low poverty incidence rural settings, and GT as an optimal strategy in high incidence poverty settings. This paper holds important lessons not only for NHI in Ghana but also for other countries implementing exemption policies.

Suggested Citation

  • Jehu-Appiah, Caroline & Aryeetey, Genevieve & Spaan, Ernst & Agyepong, Irene & Baltussen, Rob, 2010. "Efficiency, equity and feasibility of strategies to identify the poor: An application to premium exemptions under National Health Insurance in Ghana," Health Policy, Elsevier, vol. 95(2-3), pages 166-173, May.
    • Handle: RePEc:eee:hepoli:v:95:y:2010:i:2-3:p:166-173
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    1. Julia Johannsen, 2006. "Operational Poverty Targeting In Peru – Proxy Means Testing With Non-Income Indicators," Working Papers 30, International Policy Centre for Inclusive Growth.
    2. Mozaffar Qizilbash, 2002. "A note on the measurement of poverty and vulnerability in the South African context," Journal of International Development, John Wiley & Sons, Ltd., vol. 14(6), pages 757-772.
    3. Castaneda, Tarsicio & Lindert, Kathy & de la Briere, Benedicte & Fernandez, Luisa & Hubert, Celia & Larranaya, Oswaldo & Orozco, Monica & Viquez, Roxana, 2005. "Designing and implementing household targeting systems : lessons from Latin American and The United States," Social Protection Discussion Papers and Notes 32756, The World Bank.
    4. Minot, Nicholas, 2000. "Generating Disaggregated Poverty Maps: An Application to Vietnam," World Development, Elsevier, vol. 28(2), pages 319-331, February.
    5. Elbers, Chris & Fujii, Tomoki & Lanjouw, Peter & Ozler, Berk & Yin, Wesley, 2007. "Poverty alleviation through geographic targeting: How much does disaggregation help?," Journal of Development Economics, Elsevier, vol. 83(1), pages 198-213, May.
    6. Chaudhuri, Shubham & Ravallion, Martin, 1994. "How well do static indicators identify the chronically poor?," Journal of Public Economics, Elsevier, vol. 53(3), pages 367-394, March.
    7. David E. Sahn & David Stifel, 2003. "Exploring Alternative Measures of Welfare in the Absence of Expenditure Data," Review of Income and Wealth, International Association for Research in Income and Wealth, vol. 49(4), pages 463-489, December.
    8. Kanbur, Ravi, 2002. "Conceptual Challenges In Poverty And Inequality:One Development Economist'S Perspective," Working Papers 7242, Cornell University, Department of Applied Economics and Management.
    9. Mark Montgomery & Paul Hewett, 2005. "Urban poverty and health in developing countries: Household and neighborhood Effects," Demography, Springer;Population Association of America (PAA), vol. 42(3), pages 397-425, August.
    10. Chris Elbers & Jean O. Lanjouw & Peter Lanjouw, 2003. "Micro--Level Estimation of Poverty and Inequality," Econometrica, Econometric Society, vol. 71(1), pages 355-364, January.
    11. Hentschel, Jesko, et al, 2000. "Combining Census and Survey Data to Trace the Spatial Dimensions of Poverty: A Case Study of Ecuador," The World Bank Economic Review, World Bank, vol. 14(1), pages 147-165, January.
    12. Ravallion, Martin, 1994. "Measuring Social Welfare with and without Poverty Lines," American Economic Review, American Economic Association, vol. 84(2), pages 359-364, May.
    13. Grosh, M.E. & Baker, J.L., 1995. "Proxy Means Tests for Targetting Social Programs. Simulations and Speculation," Papers 118, World Bank - Living Standards Measurement.
    14. Ravallion, Martin, 1996. "Issues in Measuring and Modelling Poverty," Economic Journal, Royal Economic Society, vol. 106(438), pages 1328-1343, September.
    15. Björn Gustafsson & Li Shi & Hiroshi Sato, 2004. "Can a subjective poverty line be applied to China? Assessing poverty among urban residents in 1999," Journal of International Development, John Wiley & Sons, Ltd., vol. 16(8), pages 1089-1107.
    16. Bigman, David, et al, 2000. "Community Targeting for Poverty Reduction in Burkina Faso," The World Bank Economic Review, World Bank, vol. 14(1), pages 167-193, January.
    17. Ben D. MacArthur & Richard O. C. Oreffo, 2005. "Bridging the gap," Nature, Nature, vol. 433(7021), pages 19-19, January.
    18. Caroline Dewilde, 2004. "The Multidimensional Measurement of Poverty in Belgium and Britain: A Categorical Approach," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 68(3), pages 331-369, September.
    19. François Bourguignon & Satya R. Chakravarty, 2019. "The Measurement of Multidimensional Poverty," Themes in Economics, in: Satya R. Chakravarty (ed.), Poverty, Social Exclusion and Stochastic Dominance, pages 83-107, Springer.
    20. Chen, Shaohua & Ravallion, Martin, 2007. "Absolute poverty measures for the developing world, 1981-2004," Policy Research Working Paper Series 4211, The World Bank.
    21. Ravallion, M., 1992. "Poverty Comparisons - A Guide to Concepts and Methods," Papers 88, World Bank - Living Standards Measurement.
    22. Kraybill, David S. & Bashaasha, Bernard, 2006. "The potential gains from geographical targeting of anti-poverty programs in Uganda," African Journal of Agricultural and Resource Economics, African Association of Agricultural Economists, vol. 1(1), pages 1-12, December.
    23. Reyes, Celia M., 2006. "Alternative Means Testing Options Using CBMS," Discussion Papers DP 2006-22, Philippine Institute for Development Studies.
    24. Celia M. Reyes, 2006. "Alternative Means Testing Options Using CBMS," Development Economics Working Papers 22685, East Asian Bureau of Economic Research.
    25. Ravallion, Martin & Sen, Binayak, 1996. "When Method Matters: Monitoring Poverty in Bangladesh," Economic Development and Cultural Change, University of Chicago Press, vol. 44(4), pages 761-792, July.
    26. Morris, Saul S. & Levin, Carol E. & Armar-Klemesu, Margaret & Maxwell, Daniel & Ruel, Marie T., 1999. "Does Geographic Targeting of Nutrition Interventions Make Sense in Cities? Evidence from Abidjan and Accra," World Development, Elsevier, vol. 27(11), pages 2011-2019, November.
    27. Sharif, Iffath A., 2009. "Building a targeting system for Bangladesh based on proxy means testing," Social Protection Discussion Papers and Notes 50670, The World Bank.
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    1. Jenna Dixon & Eric Y Tenkorang & Isaac Luginaah, 2011. "Ghana's National Health Insurance Scheme: Helping the Poor or Leaving Them Behind?," Environment and Planning C, , vol. 29(6), pages 1102-1115, December.
    2. Dubois, Ute, 2012. "From targeting to implementation: The role of identification of fuel poor households," Energy Policy, Elsevier, vol. 49(C), pages 107-115.
    3. Shono, Aiko & Kondo, Masahide & Ohmae, Hiroshi & Okubo, Ichiro, 2014. "Willingness to pay for public health services in rural Central Java, Indonesia: Methodological considerations when using the contingent valuation method," Social Science & Medicine, Elsevier, vol. 110(C), pages 31-40.

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