Paper on identifying the poor in Ghana's National Health Insurance to appear in Tropical Medicine and International Health (TMIH)

31 AUGUST 2010

Genevieve Aryeetey, Caroline Jehu-Appiah, Ernst Spaan and Rob Baltussen published an article in Tropical Medicine and International Health on identification strategies of poor households in Ghana's National Health Insurance Scheme. This research is part of NICHE's project 'Reaching the poor in Ghana's National Health Insurance Scheme'. See abstract below, full text article format will be available online in the fall of this year.

RESEARCHERS: Aryeetey G; Jehu-Appiah C; Spaan E; D’exelle B; Agyepong I; Baltussen R.
TITLE: The identification of poor households for premium exemptions in Ghana’s National Health Insurance Scheme: an empirical analysis of three strategies.
OBJECTIVES: To evaluate the effectiveness of three alternative strategies to identify poor households ᅳ means testing (MT), proxy means testing (PMT), and participatory wealth ranking (PWR), in urban, rural and semi-urban settings in Ghana. The primary motivation was to inform implementation of the National Health Insurance policy of premium exemptions for the poorest households.
METHODS: We conducted a survey among 145 – 147 households per setting to collect data on consumption expenditure to estimate MT measures, and household assets to estimate PMT measures. We organized focus groups discussions to derive PWR measures. We compared errors of inclusion and exclusion of PMT and PWR relative to MT, the latter being considered the gold standard measure to identify poor households.
RESULTS: Compared to MT, the errors of exclusion and inclusion of PMT ranged between 0.46-0.63, and 0.21-0.36 respectively, and of PWR between 0.03-0.73 and 0.17-0.60 respectively, depending on the setting.
CONCLUSION: PMT and PWR have considerable errors of exclusion and inclusion in comparison to MT. PWR is a subjective measure of poverty, and has appeal since its reflects community’s perceptions on poverty. However, since its definition of the poor varies across settings, its acceptability as a uniform strategy to identify the poor in Ghana may be questionable. PMT and MT are potential strategies to identify the poor, and their relative societal attractiveness should be judged in a broader economic analysis. This study also holds relevance to other programs that require identification of the poor in low-income countries.

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