Functions[46] | Based on the frameworks of Kutzin[46], Berki and Ashcraft[47], health insurance policy documents[48–53]literature on community perceptions on MHI characteristics in SSA[31, 32, 54–63]and attributes and levels defined in previous DCEs[23–30] | |
---|---|---|
Policy attribute | Plausible levels definition (citations only provided for previous applications in DCEs) | |
Revenue mobilization | Who pays the premium | Household members, employers[30], Government |
Unit of charging premium | ||
Structure of premium | ||
• Differential based on: income, employment, age, urban–rural | ||
Premium price (level) | • Based on real cost of healthcare | |
• Based on proposed/existing insurance premiums[23, 29, 30] | ||
Forms of premium payment | ||
• Material (farm produce) or both | ||
Premium payment mechanisms | • Deduction from bank or payroll[23], institutional membership (MFI) account, salary | |
• Pay through community agents | ||
• Pay directly to insurance office | ||
Premium collection modalities | • Pay during wet, dry or all seasons | |
• Pay weekly, two-weekly[26], monthly[23], yearly[29], installment | ||
Fund and risk pooling | Unit of enrolment | Individuals[26], households, families[23], microfinance institutional or occupational groups |
Dependents eligibility | None, plus spouse, plus spouse and children[23] | |
Extent of pooling | Family/kin, community, Institutional(MFI) level, district, region, nation | |
Nature of cross-subsidization | • None | |
• Based on income, employment, risk or geographical location status | ||
• Exemptions for poor and indigents | ||
Pooled fund Management and administration | Who manages the pooled funds | |
• Community committees, | ||
• Microfinance Institutions, | ||
• NGOs, Health providers, Governmental organization | ||
Quality of customer services | Good, bad[25] | |
Insurance information communication | Not provided, weekly, monthly[26], yearly | |
Enrollment procedure (paper work involved) | • No forms to complete, few forms, lots of forms[26] | |
Services purchasing | Benefit package | Comprehensive, medium, basic packages |
Low cost vs. high cost events | ||
Low risk vs. high risk events | ||
Frequently occurring or rare events | ||
a. Specific services coverage | • Hospitalization due to medical treatment or surgery[26] | |
• Medical Consultation (by phone)[26] | ||
• Preventive care, wellness and education[27] | ||
• Emergency services[26] | ||
• Alcohol and substance abuse[26] | ||
• Treatment abroad or out of town emergency | ||
• Laboratory, x-ray and imaging | ||
• Maternal care | ||
 | • Consultations of traditional healers | |
• Transportation | ||
• Loss of income when ill | ||
• Time loss of care giver | ||
b. Cost sharing arrangements | Coverage ceiling (maximum liability)[28] | benefits within specific facilities, communities, district, national, international |
Co-payments levels | • None | |
• Out-of-pocket payment for first visit | ||
• Insurance pays only at a certain quantum of cost | ||
Benefit delivery | Cashless and re-imbursement | |
Provision | Type of providers | Public, private, faith-based or all |
Choice of provider (facility) | Choose any[27], limited to some, limited to one in the community[26], gatekeeper model | |
Location of contracted provider | • Defined in terms of distance from home or average travelling time to provider[23, 26] | |
• Defined setting: urban, rural | ||
Quality of care | ||
Reputation of affiliated providers | Outstanding, average, below average[23] | |
Waiting time for care | ||
Opening hours of health facility | Only week days, weekends as well, nights and 24Â hours[26] | |
Availability of providers | Yes/no[23] | |
Involvement in treatment decision making | Yes/no[25] |