MR Microinsurance_2012_03_29.indd - International Labour ...

What is the impact of microinsurance?
The 21 evaluations that were retained for the final analysis and are discussed in
this chapter assessed approximately 110 schemes, of which all but three were
health insurance schemes. Nine studies assessed schemes in sub-Saharan Africa,
three in the Indian sub-continent, four in China, four in South-East Asia and one
in the former Soviet Union. All of the studies were published after 2000 and
more than half either during or after 2008. This bias is due to the fact that health
policies are easier to assess because they cover events that occur more frequently
than the deaths of beneficiaries. Therefore, it is faster, and hence cheaper, to gather
the volume of claims data necessary to perform accurate analyses of health
insurance schemes. 4 On the other hand, as described in Chapter 5, health
insurance is also one of the most difficult products to deliver in a viable way.
Consequently, the results presented below should be considered as a contribution
to the sector’s understanding of microinsurance benefits, rather than an evaluation
of whether health insurance can revolutionize protection against health
shocks in developing countries.
While the authors identified numerous other evaluations of Indian microinsurance
offerings, 5 these studies were not analytically robust enough to merit
inclusion according to the selection criteria outlined above. Similarly, seven
methodically rigorous evaluations of Latin American policies were located, 6 but
the schemes in question were all fully subsidized and thus were not considered in
this review.
The increasing number of studies employing regression or more sophisticated
analytical techniques parallels a growing trend towards determining the precise
causal effects of anti-poverty interventions in the economic development community.
Of the 20 current and on-going assessments of microinsurance schemes
listed online by a stocktaking initiative of the Microinsurance Network’s Impact
Working Group, 16 use randomized controlled trials, which will vastly improve
the availability of credible information on the impact of microinsurance (Impact
Working Group of the Microinsurance Network, 2011b).
4 Interestingly, health scheme assessments are not immune to the attribution problems that plague evaluations
of other types of microinsurance. If measures of subscribers’ health status fail to improve after
they have purchased a micro-health policy, for example, both the product itself and the quality of its
benefits package could potentially be responsible. Put another way, increased access to health care will
not provide dividends if the scheme’s contracted doctors are poorly-trained or under-equipped.
5 Devadasan et al., 2004; Devadasan et al., 2007; Dror et al., 2009; Ranson, 2002; and Ranson et al., 2006.
6 Barros, 2008; Fitzpatrick, Magnoni and Thornton, 2011; Gakidou et al., 2006; Galarraga et al., 2008;
King et al., 2009; Thornton et al., 2010; and Trujillo, Portillo and Vernon, 2005.
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