Why Members Dropout? An Evaluation of Factors Affecting Renewal in Micro Health Insurance

Abstract

Micro health insurance (MHI) is an important mechanism to fight iatrogenic poverty in India. Its sustainability and viability depends, to a greater extent on the renewal of membership. This article evaluates the factors that influence renewal decisions in Sampoorna Suraksha Programme (SSP) in Karnataka. This study shows income class and chronic illness in the family to determine the renewability. The findings indicate adverse selection since low-income low-risk and high-income low-risk families dropout. From the social welfare point of view, renewal from high-risk low-income families is welcome; yet this should not jeopardize resource mobilization of SSP. Sustainable and viable operations of SSP depends on continued membership of insured population that can be achieved through external financial assistance for the poorest, wider network of hospitals and increased awareness on health insurance. Dropout rate in any MHI scheme should be kept very low to achieve deeper penetration and wider coverage especially in India where large percentage of population falls outside the insurance ambit.

Barriers and Facilitators of Community-Based Health Insurance Policy Renewal in Low- and Middle-Income Countries: A Systematic Review

“…29,36 Level of education also plays an important role in influencing the members' renewal decision as 12 of the 14 studies showed a positive association between higher levels of education and renewal decision [26][27][28][29][30][31][32][33]36,40,41,43 among 364 which seven studies revealed a statistically significant correlation. 26,27,29,31,33,36,41 Contrary to this, those who attain higher education were less likely to renew membership as noted by two studies, 25,34 but it is not statistically significant in both reports. The level of education was also used inconsistently in the included studies.…”

“…The review included 27 papers: 19 quantitative, [24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42] two mixed-method, 43,44 and six qualitative types of research. [45][46][47][48][49][50] The studies were conducted in 12 countries (seven LMICs) across two continents (Asia and Africa) among which the largest number of papers was conducted in Sub-Saharan Africa countries.…”

“…The 21 studies were conducted on renewal/dropout using quantitative data, among which 20 have employed cross-sectional study design and one study was based on panel data. Concerning the study outcome measured by the studies, 13 studies measured determinants of renewals/ dropouts without specification of membership duration, [24][25][26][27]31,33,[35][36][37][38][40][41][42] four studies identified factors related to renewal/dropout after a one-year experience of membership, [28][29][30]43 one study measured factors affecting the consistency of monthly premium payment, 32 one study modeled the decision to renew membership in the form of the number of years households are insured, 34 while another study is based on willingness to renew membership in the next renewal period. 44 Eighteen studies measured factors affecting renewal using multivariable logistic regression and one study applied a zero-inflated negative binomial model.…”

“…29,33,37,43 Among the 11 studies which reported the association between policy renewal and gender, four studies showed a statistically significant association. 35,37,38,44 Four studies found that married household heads were more likely to renew their policy compared with their counterparts of single individuals 25,30,35,42 with only one study showing a statistically significant association. 42 On the contrary, two studies reported that unmarried household heads were more likely to renew their policy compared to married and widowed individuals.…”

<p>Magnitude and Determinants of Dropout from Community-Based Health Insurance Among Households in Manna District, Jimma Zone, Southwest Ethiopia</p>

“…5,6 A continuous increase in dropout would be a death knell for the viability of any scheme because decreasing the risk pool would squeeze resource mobilization and end up with financial losses. 7 The difficulty of enrolling and retaining membership for the less endowed is seen as a reason why schemes in low-income and middle-income countries (LMICs) often fail to secure satisfactorily enrolment levels. 8 Individuals at low risk of falling ill dropout of the scheme, leaving only the high-risk individuals, which leads to the collapse of the CBHI schemes and compromises its sustainability.…”