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Table 1 Conceptual attributes and potential levels compiled from literature (adopted to the Malawian context)

From: Developing attributes and attribute-levels for a discrete choice experiment on micro health insurance in rural Malawi

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

Individual, household[26], full family[23, 27]

Structure of premium

• Flat rate[23, 27]

• 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]

• Based on WTP or qualitative studies[25–27]

Forms of premium payment

• Cash[23–27, 29, 30]

• 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

• Names of insurance provider[26, 27]

• 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]

• Pharmaceuticals/drugs prescribed[25–27]

• Preventive care, wellness and education[27]

• Vision and hearing care[26, 27]

• Emergency services[26]

• Mental health services[26, 27]

• Dental services[26, 27]

• 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

• Flat rate[23, 30]

• A percentage of cost (10%, 25%, 50%)[26, 27]

Deductibles[24, 28]

• 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

• Bad, moderate, good, very good, excellent[25–27]

Reputation of affiliated providers

Outstanding, average, below average[23]

Waiting time for care

Defined in terms of hours and minutes[26, 29]

Opening hours of health facility

Only week days, weekends as well, nights and 24 hours[26]

Availability of providers

Yes/no[23]

Involvement in treatment decision making

Yes/no[25]