MR Microinsurance_2012_03_29.indd - International Labour ...

What is the impact of microinsurance?
the overall population when pregnant. Smith and Sulzbach (2008) found that
scheme membership most effectively influences maternal health-seeking behaviour
when the applicable services are covered as benefits. Because these results
were obtained in the context of prevailing cultural norms and other factors,
directly comparing them is difficult.
While the evidence remains inconclusive and contradictory about whether
microinsurance mitigates economic disparities in respect of scheme membership
and possibly also access to care, several points merit discussion. First, equity
effects demonstrate the importance of determining the distribution of impact
alongside the more commonly calculated “average treatment effect on the treated”.
This indicator establishes the average causal differences in outcomes between the
treatment and control groups (Heckman et al., 1997). However, interpreting and
comparing equity-related evaluation results can be difficult. For example, after
observing that households headed by females were more likely to enrol than
those headed by males in Ghana, Mali and Senegal, Chankova et al. (2008) speculated
that factors related to women’s traditional status as family caregivers may
have produced these findings. Without additional information, researchers cannot
determine what caused these observations or whether they actually represent
change.
Second, the initial findings suggest that achieving equity is more complicated
than merely accommodating, or even actively encouraging, the participation of
specific client groups. Barriers to registration, accessing benefits and submitting
claims must often be specifically addressed to make policies more egalitarian.
While enrolment, utilization rates and beneficiary outcomes differ along economic,
spatial or gender lines, this does not mean that microinsurance is discriminatory
or provides poor value for low-income, rural, female or other traditionally
excluded clients. Schemes could be poorly designed, marketed or
administered, and thus unintentionally perpetuate divisions. Interestingly, during
their evaluation in Mali, Chankova et al. (2008) discovered that 71 per cent of
uninsured individuals had not enrolled because they had never seen the scheme’s
promotional materials. In other words, despite being lower-income people, they
did not join because they did not know that the plan existed.
Finally, the treatment of equity presented by the papers analysed here is
incomplete in several ways. Besides economic, spatial and gender-related disparities,
for example, historical inequalities between people of different ages, races,
colours, ethnicities, religions, sexualities and levels of disability, inter alia, can
merit exploration based upon the circumstances under which specific plans operate.
Additional design-related questions also deserve study, such as whether specific
delivery models (for example, community-based or for-profit) are more conducive
to achieving equity among policyholders (and between policyholders and
community members overall).
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