'One for All and All for One': Consensus-Building within Communities in Rural India on Their Health Microinsurance Package

Risk Management and Healthcare Policy, August 2014 Volume 2014:7 Pages 139-153 DOI 10.2147/RMHP.S66011

15 Pages Posted: 5 Aug 2014

See all articles by David M. Dror

David M. Dror

Micro Insurance Academy (MIA)

Pradeep Panda

International Institute of Health Management Research

Christina May

University of Cologne

Atanu Majumdar

Micro Insurance Academy

Ruth Koren

Tel Aviv University - Professor Sackler Faculty of Medicine

Date Written: August 4, 2014

Abstract

Introduction: This study deals with consensus by poor persons in the informal sector in rural India on the benefit-package of their community-based health insurance (CBHI). In this article we describe the process of involving rural poor in benefit-package design and assess the underlying reasons for choices they made and their ability to reach group consensus.

Methods: The benefit-package selection process entailed four steps: narrowing down the options by community representatives, plus three Choosing Healthplans All Together (CHAT) rounds conducted among female members of self-help groups. We use mixed-methods and four sources of data: baseline study, CHAT exercises, in-depth interviews, and evaluation questionnaires. We define consensus as a community resolution reached by discussion, considering all opinions, and to which everyone agrees. We use the coefficient of unalikeability to express consensus quantitatively (as variability of categorical variables) rather than just categorically (as a binomial Yes/No).

Findings: The coefficient of unalikeability decreased consistently over consecutive CHAT rounds, reaching zero (ie, 100% consensus) in two locations, and confirmed gradual adoption of consensus. Evaluation interviews revealed that the wish to be part of a consensus was dominant in all locations. The in-depth interviews indicated that people enjoyed the participatory deliberations, were satisfied with the selection, and that group decisions reflected a consensus rather than majority. Moreover, evidence suggests that pre-selectors and communities aimed to enhance the likelihood that many households would benefit from CBHI.

Conclusion: The voluntary and contributory CBHI relies on an engaging experience with others to validate perceived priorities of the target group. The strongest motive for choice was the wish to join a consensus (more than price or package-composition) and the intention that many members should benefit. The degree of consensus improved with iterative CHAT rounds. Harnessing group consensus requires catalytic intervention, as the process is not spontaneous.

Keywords: benefit-package design, micro health insurance, community-based health insurance, CBHI

Suggested Citation

Dror, David M. and Panda, Pradeep Kumar and May, Christina and Majumdar, Atanu and Koren, Ruth, 'One for All and All for One': Consensus-Building within Communities in Rural India on Their Health Microinsurance Package (August 4, 2014). Risk Management and Healthcare Policy, August 2014 Volume 2014:7 Pages 139-153 DOI 10.2147/RMHP.S66011 , Available at SSRN: https://ssrn.com/abstract=2475788

David M. Dror (Contact Author)

Micro Insurance Academy (MIA) ( email )

New Delhi, NCR
India
+41 78 790 6789 (Phone)

HOME PAGE: http://https://en.everybodywiki.com/

Pradeep Kumar Panda

International Institute of Health Management Research ( email )

Plot No. 3, Sector – 18A
Dwarka, New Delhi 110075
India

Christina May

University of Cologne ( email )

Albertus-Magnus-Platz
Cologne, 50923
Germany

Atanu Majumdar

Micro Insurance Academy ( email )

52-B, 1st floor
Okhla Industrial Estate, Phase III
New Delhi, 110020
India

Ruth Koren

Tel Aviv University - Professor Sackler Faculty of Medicine ( email )

Ramat Aviv
Tel-Aviv, 6997801
Israel

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