Do informal risk sharing networks crowd out public voluntary health insurance? Evidence from Vietnam

Jowett, Matthew

doi:10.1080/0003684032000079152

Cited by 63 publications

(52 citation statements)

References 21 publications

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“…It was hypothesised that people who had not borrowed money or borrowed money from immediate family, relatives or friends only were less likely to enrol in CBHI due to the "negative" effects of bonding social capital. This is supported by a study on voluntary health insurance in Vietnam (Jowett, 2003) which showed that borrowing money from informal financial networks (family and friends)…”

Section: Variablesmentioning

confidence: 61%

Can social capital help explain enrolment (or lack thereof) in community-based health insurance? Results of an exploratory mixed methods study from Senegal

Mladovsky¹,

Soors²,

Ndiaye³

et al. 2014

Social Science & Medicine

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Original citation:Mladovsky, Philipa, Soors, Werner, Ndiaye, Pascal, Ndiaye, Alfred and Criel, Bart (2014) 2 Abstract CBHI has achieved low population coverage in West Africa and elsewhere. Studies seeking to explain this point to inequitable enrolment, adverse selection, lack of trust in scheme management and information and low quality of health care. Interventions to address these problems have been proposed yet enrolment rates remain low. This exploratory study proposes that an underresearched determinant of CBHI enrolment is social capital. Fieldwork comprising a household survey and qualitative interviews was conducted in Senegal in 2009. Levels of bonding and bridging social capital among 720 members and non-members of CBHI across three case study schemes are compared. The results of the logistic regression suggest that, controlling for age and gender, in all three case studies members were significantly more likely than non-members to be enrolled in another community association, to have borrowed money from sources other than friends and relatives and to report having control over all community decisions affecting daily life. In two case studies, having privileged social relationships was also positively correlated with enrolment. After controlling for additional socioeconomic and health variables, the results for borrowing money remained significant. Additionally, in two case studies, reporting having control over community decisions and believing that the community would cooperate in an emergency were significantly positively correlated with enrolment. The results suggest that CBHI members had greater bridging social capital which provided them with solidarity, risk pooling, financial protection and financial credit. Qualitative interviews with 109 individuals selected from the household survey confirm this interpretation. The results ostensibly suggest that CBHI schemes should build on bridging social capital to increase coverage, for example by enrolling households through community associations.However, this may be unadvisable from an equity perspective. It is concluded that since enrolment in CBHI was less common not only among the poor, but also among those with less social capital and less power, strategies should focus on removing social as well as financial barriers to obtaining financial protection from the cost of ill health.

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Section: Variablesmentioning

confidence: 61%

Can social capital help explain enrolment (or lack thereof) in community-based health insurance? Results of an exploratory mixed methods study from Senegal

Mladovsky¹,

Soors²,

Ndiaye³

et al. 2014

Social Science & Medicine

View full text Add to dashboard Cite

show abstract

“…However, there is a second argument in the CBHI literature that turns this hypothesis on its head and holds that strong intra-group bonds actually prevent the emergence of successful CBHI (Meessen, 2002, Atim, 1999, Jowett, 2003. An example of this comes from Ghana where, in the face of conflicting loyalties between a CBHI scheme and members of their community, field assistants apparently connived with community members in the practice of evading the stipulation of family membership, a mechanism designed to prevent adverse selection (Atim, 1999).…”

Section: Negative Role Of Bonding Social Capitalmentioning

confidence: 99%

“…Also supporting the negative view of social capital, Jowett (Jowett, 2003), using data from voluntary health insurance (which operates much like CBHI) in Vietnamese provinces, takes issue with Hsiao's (Hsiao, 2001) argument that social capital facilitates collective action and willingness to pay. The results of Jowett's study, which controls for a range of health and socio-economic variables, showed that high levels of two proxies of social capital -perceptions of social cohesion and informal financial networks -were correlated with lower, not higher, rates of take-up of community-based voluntary health insurance, suggesting that intra-community bonding social capital 'crowds out' voluntary health insurance.…”

Section: Negative Role Of Bonding Social Capitalmentioning

confidence: 99%

“…By reviewing the CBHI literature, we identified a core set of studies that consider the social context of CBHI schemes (Atim, 1999, Bloom and Shenglan, 1999, Criel and Waelkens, 2003, Franco, 2004, Hsiao, 2001, Jowett, 2003, Meessen, 2002, Ron, 1999, Schneider, 2004, Zhang et al, 2006. In the remainder of the paper, the adapted, simplified version of Woolcock's framework is populated with these studies.…”

Section: Understanding the Feasibility Of Cbhi Through The Lens Of Thmentioning

confidence: 99%

“…However, research in China (Hsiao, 2001, Zhang et al, 2006) is one of only two explicit attempts take this up and measure the effect of social capital on CBHI (the other is a study in Vietnam (Jowett, 2003) (see below). In the Chinese research, social capital is employed only in the Putnamian sense to mean a stock of "social cohesion and solidarity".…”

Section: 1mentioning

confidence: 99%

See 2 more Smart Citations

A Conceptual Framework for Community-Based Health Insurance in Low-Income Countries: Social Capital and Economic Development

Mladovsky

Mossialos

2008

World Development

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Current thinking in major international development agencies construes community-based health insurance (CBHI) as a transitional mechanism to achieving universal coverage for health care in lowincome countries. The policy link between CBHI and universal coverage is implicitly determined by the historical experience of mutual health insurance in countries such as Germany and Japan in the 19 th century, where the socioeconomic context was dramatically different to that of today's much less successful schemes. This paper argues that the economic and health system frameworks employed in the analysis of CBHI have not taken into account context-dependent considerations such as goals, values and power. It is proposed that a critical engagement with social capital theories could contribute to our understanding of why CBHI schemes do not appear on course to develop according to the 19 th century precedent, achieving significant levels of population coverage in a sustainable way.A framework of social capital and economic development is used to organize and interpret existing evidence and information on CBHI. This process suggests that solidarity, trust, extra-community networks, vertical civil society links and state-society relations at the local level affect the possibility of success of CBHI. To this extent, it may be possible to talk of "social determinants of CBHI". In order to align themselves to local community goals and values, CBHI schemes may need to actively foster certain types of vertical and horizontal bridging relations which could result in the evolution of structures and operations quite different to those proposed by current models of CBHI.

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Impact evaluation of India's ‘Yeshasvini’ community‐based health insurance programme

2010

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Using propensity score matching techniques, the study evaluates the impact of India's Yeshasvini community-based health insurance programme on health-care utilisation, financial protection, treatment outcomes and economic well-being. The programme offers free out-patient diagnosis and lab tests at discounted rates when ill, but, more importantly, it covers highly catastrophic and less discretionary in-patient surgical procedures. For its impact evaluation, 4109 randomly selected households in villages in rural Karnataka, an Indian state, were interviewed using a structured questionnaire. A comprehensive set of indicators was developed and the quality of matching was tested. Generally, the programme is found to have increased utilisation of health-care services, reduced out-of-pocket spending, and ensured better health and economic outcomes. More specifically, however, these effects vary across socio-economic groups and medical episodes. The programme operates by bringing the direct price of health-care down but the extent to which this effectively occurs across medical episodes is an empirical issue. Further, the effects are more pronounced for the better-off households. The article demonstrates that community insurance presents a workable model for providing high-end services in resource-poor settings through an emphasis on accountability and local management.

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Do informal risk sharing networks crowd out public voluntary health insurance? Evidence from Vietnam

Cited by 63 publications

References 21 publications

Can social capital help explain enrolment (or lack thereof) in community-based health insurance? Results of an exploratory mixed methods study from Senegal

Can social capital help explain enrolment (or lack thereof) in community-based health insurance? Results of an exploratory mixed methods study from Senegal

A Conceptual Framework for Community-Based Health Insurance in Low-Income Countries: Social Capital and Economic Development

Impact evaluation of India's ‘Yeshasvini’ community‐based health insurance programme

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