RESUMO
Even though access to health insurance in Colombia has improved since the implementation of the 1993 health reforms (Law 100), universal coverage has not yet been accomplished. There is still a segment of the population under the low-income (subsidized) health insurance policy or without health insurance altogether. The purpose of this research was to identify preferences and behavior regarding health insurance among the subsidized rural population in La Guajira, Colombia, and to understand why that population remains under the subsidized health insurance policy. The field experiment gathered information from 400 households regarding their socioeconomic situation, health conditions, and preferences for health insurance characteristics. Results suggest that the surveyed population gives priority to expanded family coverage, physician and hospital choice, and access to specialists, rather than to attributes associated with co-payments or premiums. That indicates that people value healthcare benefits and family coverage more than health insurance expenses, and policy makers could use these preferences to enroll subsidized population into the contributory regime.
Assuntos
Comportamento do Consumidor/estatística & dados numéricos , Cobertura do Seguro/estatística & dados numéricos , Seguro Saúde , População Rural/estatística & dados numéricos , Adulto , Colômbia , Feminino , Financiamento Governamental/organização & administração , Nível de Saúde , Humanos , Cobertura do Seguro/organização & administração , Seguro Saúde/organização & administração , Seguro Saúde/estatística & dados numéricos , Masculino , Fatores Socioeconômicos , Inquéritos e QuestionáriosRESUMO
Many low-income individuals from around the world rely on local food vendors for daily sustenance. These small vendors quickly provide convenient, low-priced, tasty foods, however, they may be low in nutritional value. These vendors serve as an opportunity to use established delivery channels to explore the introduction of healthier products, e.g. fresh salad and fruits, to low-income populations. We sought to understand preferences for items prepared in Comedores Populares (CP), government-supported food vendors serving low-income Peruvians, to determine whether it would be feasible to introduce healthier items, specifically fruits and vegetables. We used a best-worst discrete choice experiment (DCE) that allowed participants to select their favorite and least favorite option from a series of three hypothetical menus. The characteristics were derived from a series of formative qualitative interviews conducted previously in the CPs. We examined preferences for six characteristics: price, salad, soup, sides, meat and fruit. A total of 432 individuals, from two districts in Lima, Peru responded to a discrete choice experiment and demographic survey in 2012. For the DCE, price contributed the most to individual's utility relative to the other attributes, with salad and soup following closely. Sides (e.g. rice and beans) were the least important. The willingness to pay for a meal with a large main course and salad was 2.6 Nuevos Soles, roughly a 1 Nuevo Sol increase from the average menu price, or USD $0.32 dollars. The willingness to pay for a meal with fruit was 1.6 Nuevo Soles. Overall, the perceived quality of service and food served in the CPs is high. The willingness to pay indicates that healthier additions to meals are feasible. Understanding consumer preferences can help policy makers design healthier meals in an organization with the potential to scale up to reach a considerable number of low-income families.
Assuntos
Comportamento de Escolha , Comportamento do Consumidor/economia , Preferências Alimentares/psicologia , Alimentos/economia , Pobreza , Adulto , Feminino , Humanos , Masculino , Peru , Inquéritos e Questionários , População UrbanaRESUMO
Despite enacting a universal healthcare system in 1993, many Colombians do not participate. Understanding perceptions of the system could help the government market certain features or adjust benefits in order to increase enrollment. Using La Guajira, Colombia, as a case study, we surveyed uninsured rural households regarding insurance preferences, values and beliefs, and perceptions of available services. Four hundred heads of households responded in La Guajira, Colombia. Respondents reported high levels of long-term uninsurance. Overall, the quality of services in the government-run system is perceived as better than being uninsured, but there appear to be constraints on enrollment. Rural Colombians value more family coverage and better choice of physicians, but offering better benefits may not be enough. Many cited access barriers, so reducing these barriers may also increase enrollment. Further surveys in other parts of Colombia should be undertaken to confirm results.
Assuntos
Cobertura do Seguro , Seguro Saúde/estatística & dados numéricos , Pessoas sem Cobertura de Seguro de Saúde , População Rural , Cobertura Universal do Seguro de Saúde , Adulto , Colômbia , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e QuestionáriosRESUMO
BACKGROUND: In many countries, health insurance coverage is the primary way for individuals to access care. Governments can support access through social insurance programmes; however, after a certain period, governments struggle to achieve universal coverage. Evidence suggests that complex individual behaviour may play a role. OBJECTIVES: Using a choice experiment, this research explored consumer preferences for health insurance in Colombia. We also evaluated whether preferences differed across consumers with differing demographic and health status factors. METHODS: A household field experiment was conducted in Bogotá in 2010. The sample consisted of 109 uninsured and 133 low-income insured individuals. Each individual evaluated 12 pair-wise comparisons of hypothetical health plans. We focused on six characteristics of health insurance: premium, out-of-pocket expenditure, chronic condition coverage, quality of care, family coverage and sick leave. A main effects orthogonal design was used to derive the 72 scenarios used in the choice experiment. Parameters were estimated using conditional logit models. Since price data were included, we estimated respondents' willingness to pay for characteristics. RESULTS: Consumers valued health benefits and family coverage more than other attributes. Additionally, differences in preferences can be exploited to increase coverage. The willingness to pay for benefits may partially cover the average cost of providing them. CONCLUSION: Policy makers might be able to encourage those insured via the subsidized system to enrol in the next level of the social health insurance scheme through expanding benefits to family members and expanding the level of chronic condition coverage.