MR Microinsurance_2012_03_29.indd - International Labour ...

74 Emerging issues
Utilization rates
By removing cost and other barriers to accessing covered goods and services,
microinsurance theoretically encourages and thus increases clients’ utilization of
these benefits. In contrast, due to factors ranging from the unavailability of funds
to non-functioning transportation options, uninsured individuals may delay or
completely forgo seeking solutions even when their situations become dire.
The impact of microinsurance on utilization rates is evaluated fairly frequently.
On the basis of this evidence, it appears that microinsurance improves
policyholders’ utilization rates for health-related plans. Sixteen studies reported
positive findings or mixed positive and insignificant findings, whereas only one
study had insignificant findings. Among the affirmative results, for example,
Msuya et al. (2004) determined that policyholders of the United Republic of
Tanzania’s Community Health Fund were 15 per cent more likely to seek formal
care than their uninsured counterparts. Similarly, Polonsky et al. (2009) found
that members of nine Oxfam-operated Armenian schemes visited health posts
with 3.5 times the frequency of non-members.
Of the studies with mixed findings, Smith and Sulzbach’s (2008) assessment
of the maternal health service utilization patterns of members of 27 Senegalese
mutuelles, four Malian mutual health organizations and Ghana’s Nkoranza
Health Insurance Scheme found that membership was associated with significantly
higher use of prenatal and delivery care in Mali. While policyholders of
Senegalese schemes that provided baby delivery cover were more likely to have
facility-based births, the mutuelles did not appreciably increase already high rates
of prenatal care-seeking; neither did the Ghanaian plan, which only covered Caesarean
sections. Contrasting results were also obtained by Gnawali et al. (2009)
in an assessment of Burkina Faso’s Nouna District Health Scheme. While the
overall increase in outpatient visits given illness was 40 percentage points higher
among subscribers, this increase was only significant among the richest quartile
of policyholders. In his data on India’s VimoSEWA Ranson (2001) could not
show any significant difference in the probability of insured being hospitalized.
Interestingly, Diop et al. (2006) uncovered unexpected collateral effects among
microinsurance plan members. Although Ghana’s Nkoranza plan did not cover
outpatient care, the researchers calculated that subscribers increased their consumption
of such services nonetheless.
Despite being one of the most commonly assessed indicators, experts debate
whether increased utilization unequivocally demonstrates the positive impact of
microinsurance. Poorly designed microinsurance schemes can encourage moral
hazard or adverse selection, while improved use of services by policyholders
could instead represent the misallocation of resources and crowding-out of access
to people with more legitimate needs. Others argue that increased subscriber