tailieunhanh - DESIGN OF INCENTIVES IN COMMUNITY BASED HEALTH INSURANCE SCHEMES

Many of the early compliance models assumed that audits were expensive but that penalties could be imposed at low cost to the enforcing agency once an error had been detected. It is not surprising that those models typically showed that, subject to a fixed-budget constraint, the combination of high penalties and low audit rates was socially optimal (McCubbin, 2004). Those results are sensitive to several underlying assumptions. First, feelings about risk vary from one group to another; younger people, for example, could be less risk-averse than older people are. Second, penalties are not imposed without cost | WORKING PAPER NO. 95 DESIGN OF INCENTIVES IN COMMUNITY BASED HEALTH INSURANCE SCHEMES RAJEEV AHUJA JOHANNES JUTTING FEBRUARY 2003 INDIAN COUNCIL FOR RESEARCH ON INTERNATIONAL ECONOMIC RELATIONS Core-6A 4th Floor India Habitat Centre Lodi Road New Delhi-110 003 Contents 1 2 The Need for Conceptual Clarity Differences between Informal Insurance Market Insurance and Community Based Insurance 3 Addressing Important Incentive Problems in Community Based Insurance Schemes Adverse Selection Moral Hazard and Incentives for Incentives to Reduce Adverse Selection Enrolling the Family as a Unit .8 Incentives to reduce the Moral Hazard Problem Establishing a Group Insurance Incentives to Increase the Risk Pool Managers Payment 4 The Role of Public Policy in Setting the Right 5 Table Table 1 Important Differences in Alternate Insurance Figure Figure 1 Claims Variation and Size of Risk Foreword Health is increasingly being viewed not only as an end in itself but also as a crucial input into the development process. Indeed a positive link between health and economic growth is widely established particularly for low-income countries. As these countries embrace market reforms as well as integrate themselves with the world economy there is a concern about insulating the poor from any possible adverse consequences. While the role of state is on the retreat in most economic spheres in social sectors such as health state s role will continue to be important. The debate on health sector reforms in India is currently underway. One aspect of the debate is the challenge of reducing the burden of health care costs by converting out-of-pocket expenditure into prepayment schemes through insurance--whether social insurance market-based or community based insurance. The concept of community based insurance seems appealing and may even .