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Comparative Study
. 2016 Apr;14(2):195-204.
doi: 10.1007/s40258-016-0222-9.

Household Size and the Decision to Purchase Health Insurance in Cambodia: Results of a Discrete-Choice Experiment with Scale Adjustment

Sachiko Ozawa  1 , Simrun Grewal  2 , John F P Bridges  3   4
Affiliations
Comparative Study

Household Size and the Decision to Purchase Health Insurance in Cambodia: Results of a Discrete-Choice Experiment with Scale Adjustment

Sachiko Ozawa et al. Appl Health Econ Health Policy. 2016 Apr.

Abstract

Background: Community-based health insurance (CBHI) schemes have been introduced in low- and middle-income countries to increase health service utilization and provide financial protection from high healthcare expenditures.

Objective: We assess the impact of household size on decisions to enroll in CBHI and demonstrate how to correct for group disparity in scale (i.e. variance differences).

Methods: A discrete choice experiment was conducted across five CBHI attributes. Preferences were elicited through forced-choice paired comparison choice tasks designed based on D-efficiency. Differences in preferences were examined between small (1-4 family members) and large (5-12 members) households using conditional logistic regression. Swait and Louviere test was used to identify and correct for differences in scale.

Results: One-hundred and sixty households were surveyed in Northwest Cambodia. Increased insurance premium was associated with disutility [odds ratio (OR) 0.61, p < 0.01], while significant increase in utility was noted for higher hospital fee coverage (OR 10.58, p < 0.01), greater coverage of travel and meal costs (OR 4.08, p < 0.01), and more frequent communication with the insurer (OR 1.33, p < 0.01). While the magnitude of preference for hospital fee coverage appeared larger for the large household group (OR 14.15) compared to the small household group (OR 8.58), differences in scale were observed (p < 0.05). After adjusting for scale (k, ratio of scale between large to small household groups = 1.227, 95 % confidence interval 1.002-1.515), preference differences by household size became negligible.

Conclusion: Differences in stated preferences may be due to scale, or variance differences between groups, rather than true variations in preference. Coverage of hospital fees, travel and meal costs are given significant weight in CBHI enrollment decisions regardless of household size. Understanding how community members make decisions about health insurance can inform low- and middle-income countries' paths towards universal health coverage.

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Figures

Fig. 1
Fig. 1
Example discrete choice experiment choice task
Fig. 2
Fig. 2
Mean predicted probabilities of selection based on community-based health insurance (CBHI) attributes
Fig. 3
Fig. 3
Plot to determine the value of scale parameter k
Fig. 4
Fig. 4
Visual comparison of coefficient values by household size: fit before and after correction for scale
See this image and copyright information in PMC

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References

    1. Carrin G, Waelkens MP, Criel B. Community-based health insurance in developing countries: a study of its contribution to the performance of health financing systems. Trop Med Int Health. 2005;10(8):799–811. doi: 10.1111/j.1365-3156.2005.01455.x. - DOI - PubMed
    1. Soors W, Devadasan N, Varatharajan D, Criel B. Community health insurance and universal coverage: multiple paths, many rivers to cross. Geneva: World Health Organization; 2010.
    1. Jacobs B, Bigdeli M, van Pelt M, Ir P, Salze C, Criel B. Bridging community-based health insurance and social protection for health care—a step in the direction of universal coverage? Trop Med Int Health. 2008;13(2):140–143. doi: 10.1111/j.1365-3156.2007.01983.x. - DOI - PubMed
    1. Jehu-Appiah C, Aryeetey G, Spaan E, de Hoop T, Agyepong I, Baltussen R. Equity aspects of the National Health Insurance Scheme in Ghana: Who is enrolling, who is not and why? Soc Sci Med. 2011;72(2):157–165. doi: 10.1016/j.socscimed.2010.10.025. - DOI - PubMed
    1. Olaniyan O, Sunkanmi OA. Demand for child healthcare in Nigeria. Global J Health Sci. 2012;4(6):129–140. doi: 10.5539/gjhs.v4n6p129. - DOI - PMC - PubMed

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