Dealing with Internal Inconsistency in Double-Bounded Dichotomous Choice: An Application to Community-Based Health Insurance

Contingent valuation method is commonly used in the field of health economics in an attempt to help policy maker in taking decisions. The use of the double-bounded dichotomous choice format results in a substantial gain in statistical efficiency over the single bounded dichotomous choice format. Yet, this efficiency gain comes at the cost of biasness known as internal inconsistency. This paper aims at reducing this internal inconsistency in double-bounded dichotomous choice by using the certainty calibration technique in a community-based health insurance study. Findings confirm the internal inconsistency between the initial and the follow-up responses and the statistical efficiency gains of the double-bounded dichotomous choice over the single-bounded dichotomous choice. Furthermore, the use of certainty calibration reduces this internal inconsistent pattern in responses and still maintains efficiency gain. We further discuss the policy implications.Contingent valuation; internal inconsistency; certainty calibration; community-based health insurance

Community-based health insurance and social capital: a review

SpringerOpen Licence CC-BYInternational audienceCommunity-Based Health Insurance (CBHI) is an emerging concept for providing financial protection against the cost of illness and improving access to quality health services for low-income rural households who are excluded from formal insurance. CBHI is currently being provided in some rural areas in developing countries and there is ongoing research about its impact on the well-being of the poor in these areas. However, the success of CBHI revolves around the existence of social capital in the community. This has led researchers to explore the impact of CBHI on the well-being of the poor in rural areas, especially as it relates to social capital. The overall objective of this paper is to review recent developments that address the link between CBHI and social capital. Policy implications are also discussed

Essays on assessing Households' Preferences for community-based health insurance

Le financement des soins de santé de qualité constitue un défi majeur pour les pays en développement. Malgré les efforts consentis pour améliorer l’offre des services de santé, une frange importante de la population n’a toujours pas accès aux soins de santé. La faible croissance économique, le manque des ressources, la corruption et les contraintes imposées au secteur public peuvent expliquer pourquoi la conception d’un système de financement des soins de santé est complexe. Au cours des deux dernières décennies, il y a eu une baisse de l'utilisation des services de santé après l'introduction du recouvrement des coûts dans les établissements de santé publics. Les personnes les plus touchées par cette politique sont les ménages à faibles revenus notamment dans les zones rurales qui sont le plus souvent vulnérables aux maladies. L'assurance communautaire a été proposée comme une alternative pour améliorer une meilleure accessibilité des ménages à faibles revenus aux soins de santé. L'assurance communautaire apparaît ainsi comme un outil de protection sociale pour un grand nombre de personnes qui, autrement, n'auraient pas une couverture face au risque maladie. Toutefois, un tel système d’assurance maladie ne peut avoir des effets à long terme que s’il existe une forte préférence des ménages pour une telle politique, et un capital social dans les zones rurales. Evaluer les préférences des ménages pour l'assurance communautaire est importante pour la formulation des recommandations de politique économique. Une connaissance adéquate des déterminants de la demande pour l'assurance communautaire est aussi essentielle pour l'élaboration de stratégies visant à accroître l’allocation des ressources, et à améliorer la qualité des services. La présente étude a pour objet d’évaluer les préférences des ménages pour l’assurance communautaire en milieu rural camerounais. L’usage de la méthode d’évaluation contingente suggère que les ménages à faibles revenus sont disposés à payer pour l’assurance communautaire. En outre, le capital social a un effet positif et significatif sur la demande. L’usage des doubles questions binaires pour évaluer des préférences des ménages est incompatible avec les incitations et sujets à un shift effect hétérogène expliqué par les caractéristiques intrinsèques des ménages. Les ménages très certains de leurs réponses ne sont pas sujets aux anomalies comportementales. Enfin, les préférences des ménages sont inter-indépendantes du fait des interactions spatiales expliquées par les normes socialesThe financing of quality healthcare is a major challenge for developing countries. Despite efforts to improve the provision of healthcare services, a significant proportion of the population does not always have access to healthcare services. Low economic growth, lack of economic resources, corruption and constraints on the public sector could explain why the design of a system of financing healthcare is complex. Over the past two decades, there has been a decline in the use of healthcare services after the introduction of cost recovery in public health facilities. Those most affected by this policy are low-income households particularly in rural areas that are most often vulnerable to diseases. The community-based health insurance has been proposed as an alternative to improve better access to low-income households to healthcare services. The community-based health insurance is thus a tool of social protection for many households who otherwise would not have formal insurance. However, such a health insurance scheme can have long-term effects if households have a strong preference for it, and there is social capital in rural areas. Assessing the preferences of households for the community-based health insurance is important for the formulation of policy recommendations. Adequate knowledge on the determinants of demand for the community-based health insurance is essential for developing strategies to increase resource allocation, and improve the quality of services. This study aims at assessing the preferences of households for community-based health insurance in rural areas of Cameroon. The use of contingent valuation method suggests that low-income households are willing to pay for the community-based health insurance. Furthermore, social capital has a positive and significant effect on the demand, and the use of double-bounded dichotomous choice to assess the preferences of households is incentive incompatible. We also found that there is heterogeneous shift effect in preferences anomalies and could be mostly explained by the salient characteristics of households. A striking result is that more certain households are not subjected to preference anomalies. Lastly, there is spatial dependence in the preferences of households explained by social norm

Determinants of willingness-to-pay for renewable energy: does the age of nuclear power plant reactors matter?

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The economic value of improved air quality in urban Africa: a contingent valuation survey in Douala, Cameroon

International audienceThis study investigates the effects of ‘time to think’ and ‘ballot box’ on willingness-to-pay, while providing the first empirical evidence on assessing the benefits of an air quality improvement program in urban Africa. Our hypothetical referendum scenario proposes to reduce the air pollution related morbidity rate in Douala, Cameroon by 25 per cent in exchange for a one-time surcharge on the electricity bill of each respondent. We find that on average WTP decreases by nearly one-fourth when allocating respondents time to think but markedly increases when we use a ‘ballot box’ approach allowing respondents to state their willingness privately. Our results suggest that on average households are willing to pay US$0.42 per month (0.2 per cent of household annual income). We conclude that total citywide benefits are unlikely to exceed the costs of implementing such a program at this point, although this situation may change quickly with increasing economic growth

Socioeconomic inequality in tobacco use in Kenya: a concentration analysis

International audienceThis paper aims at assessing and exploring socioeconomic inequalities in tobacco use in Kenya. Using the theory of fundamental causes, and concentration index, we investigate the determinants of tobacco use, and whether it disproportionately affects the poor. All data used in this study emanated from the 2014 Global Adult Tobacco Survey implemented in Kenya on a nationally representative sample of men and women aged 15 years and older. Our results suggest a link between tobacco use and socioeconomic inequality. Overall, poorer households are more affected by tobacco use than richer households. This socioeconomic inequality is more evident among men and households living in urban areas. The decomposition of the concentration index indicates that the overall socioeconomic inequality for current tobacco smokers is explained by 69.11% of household wealth. To reduce the prevalence rate of smoking in Kenya, policymakers could design and implement tobacco control programs through the equity lens. Community health workers could be used to promote non-smoking behaviors among the poor

Using respondents' uncertainty scores to mitigate hypothetical bias in community-based health insurance studies

International audienceCommunity-based health insurance has been implemented in several developing countries to help the poor to gain access to adequate health-care services. Assessing what the poor are willing to pay is of paramount importance for policymaking. The contingent valuation method, which relies on a hypothetical market, is commonly used for this purpose. But the presence of the hypothetical bias that is most often inherent in this method tends to bias the estimates upward and compromises policymaking. This paper uses respondents' uncertainty scores in an attempt to mitigate hypothetical bias in communitybased health insurance in one rural setting in Cameroon. Uncertainty scores are often employed in single dichotomous choice surveys. An originality of the paper is to use such an approach in a double-bounded dichotomous choice survey. The results suggest that this instrument is effective at decreasing the mean WTP