Incidence of illness among resource-poor households: evidence from five locations in India.

BACKGROUND & OBJECTIVE: This study examines the association between household attributes and perceived morbidity within resource-poor house holds (HHs) in India at five locations. This presents an innovation compared to most epidemiological studies, which focus on associations between the incidence of an illness and characteristics of the ill person. METHODS: Perceived morbidity was represented by a variable called "Incidence of illness in a HH" (IIH) = the number of self reported illness episodes during three months preceding the survey, divided by household size. Variables were analyzed through bivariate correlation and multivariate linear regression. The evidence was based on a HH survey conducted in 2005 in Maharashtra, Bihar, and Tamil Nadu. Data yield reflected responses of 3,531 HHs, representing 17,323 individuals and 4,316 illness episodes. RESULTS: Analysis showed that incidence of illness among women was higher; the under 5 yr olds and elderly (+55) were particularly vulnerable. However, in the multivariate linear regression model, gender ratio within HHs became an insignificant explanatory variable. Age distribution had a small but significant effect. Household size and the level of education in the HH were negatively and significantly associated with IIH. The regression analysis showed that income had a modest positive effect, but improved housing was associated with reduced IIH. Large differences were noted in IIH across locations. INTERPRETATION & CONCLUSION: Our findings showed that attributes of the unit household, including type of house, income, education and size, have significant effects on IIH; variability in IIH cannot solely be explained by age and gender of HH members.

Reinsurance of health insurance for the informal sector.

Deficient financing of health services in low-income countries and the absence of universal insurance coverage leaves most of the informal sector in medical indigence, because people cannot assume the financial consequences of illness. The role of communities in solving this problem has been recognized, and many initiatives are under way. However, community financing is rarely structured as health insurance. Communities that pool risks (or offer insurance) have been described as micro-insurance units. The sources of their financial instability and the options for stabilization are explained. Field data from Uganda and the Philippines, as well as simulated situations, are used to examine the arguments. The article focuses on risk transfer from micro-insurance units to reinsurance. The main insight of the study is that when the financial results of micro-insurance units can be estimated, they can enter reinsurance treaties and be stabilized from the first year. The second insight is that the reinsurance pool may require several years of operation before reaching cost neutrality.