Ernst Spaan

Efficiency, equity and feasibility of strategies to identify the poor: an application to premium exemptions under National Health Insurance in Ghana.

OBJECTIVES This paper outlines the potential strategies to identify the poor, and assesses their feasibility, efficiency and equity. Analyses are illustrated for the case of premium exemptions under National Health Insurance (NHI) in Ghana. METHODS A literature search in Medline search was performed to identify strategies to identify the poor. Models were developed including information on demography and poverty, and costs and errors of in- and exclusion of these strategies in two regions in Ghana. RESULTS Proxy means testing (PMT), participatory welfare ranking (PWR), and geographic targeting (GT) are potentially useful strategies to identify the poor, and vary in terms of their efficiency, equity and feasibility. Costs to exempt one poor individual range between US

Identification of poor households for premium exemptions in Ghana's National Health Insurance Scheme: empirical analysis of three strategies

11.63 and US

Community concepts of poverty: an application to premium exemptions in Ghana's National Health Insurance Scheme

66.67, and strategies may exclude up to 25% of the poor. Feasibility of strategies is dependent on their aptness in rural/urban settings, and administrative capacity to implement. A decision framework summarizes the above information to guide policy making. CONCLUSIONS We recommend PMT as an optimal strategy in relative low poverty incidence urbanized settings, PWR as an optimal strategy in relative low poverty incidence rural settings, and GT as an optimal strategy in high incidence poverty settings. This paper holds important lessons not only for NHI in Ghana but also for other countries implementing exemption policies.

Costs, equity, efficiency and feasibility of identifying the poor in Ghana’s National Health Insurance Scheme: empirical analysis of various strategies

Objectives  To evaluate the effectiveness of three alternative strategies to identify poor households: means testing (MT), proxy means testing (PMT) and participatory wealth ranking (PWR) in urban, rural and semi‐urban settings in Ghana. The primary motivation was to inform implementation of the National Health Insurance policy of premium exemptions for the poorest households.

Shifts in the European Discourses on Migration and Development

BackgroundPoverty is multi dimensional. Beyond the quantitative and tangible issues related to inadequate income it also has equally important social, more intangible and difficult if not impossible to quantify dimensions. In 2009, we explored these social and relativist dimension of poverty in five communities in the South of Ghana with differing socio economic characteristics to inform the development and implementation of policies and programs to identify and target the poor for premium exemptions under Ghana’s National Health Insurance Scheme.MethodsWe employed participatory wealth ranking (PWR) a qualitative tool for the exploration of community concepts, identification and ranking of households into socioeconomic groups. Key informants within the community ranked households into wealth categories after discussing in detail concepts and indicators of poverty.ResultsCommunity defined indicators of poverty covered themes related to type of employment, educational attainment of children, food availability, physical appearance, housing conditions, asset ownership, health seeking behavior, social exclusion and marginalization. The poverty indicators discussed shared commonalities but contrasted in the patterns of ranking per community.ConclusionThe in-depth nature of the PWR process precludes it from being used for identification of the poor on a large national scale in a program such as the NHIS. However, PWR can provide valuable qualitative input to enrich discussions, development and implementation of policies, programs and tools for large scale interventions and targeting of the poor for social welfare programs such as premium exemption for health care.

New directions in exploring the migration industries: introduction to special issue

Objectives  To analyse the costs and evaluate the equity, efficiency and feasibility of four strategies to identify poor households for premium exemptions in Ghana’s National Health Insurance Scheme (NHIS): means testing (MT), proxy means testing (PMT), participatory wealth ranking (PWR) and geographic targeting (GT) in urban, rural and semi‐urban settings in Ghana.

Migration decision-making and migration industry in the Indonesia–Malaysia corridor

The issue of migration and development is currently high on the agenda of both development agencies and research institutes in several European countries. It used to be discussed during the 1960/1970s within a framework which, among others, comprised push-and pull factors in migration, brain drain, remittances and return migration. Its return on the development agenda occurs within the context of European post-modern societies, globalization and transnationalism. Key notions now are remittances and foreign direct investment, knowledge transfer, brain gain, transnational entrepreneurship and diasporas. This paper aims to explain the shifts in paradigms and discourses, with reference to the European Union, and particularly in the Netherlands and Germany. Research efforts and policy documents were scrutinized to trace the shifts in discourses. Moreover, the role of different actors in the debate -government agencies, migrant organizations, development funding agencies, and research institutes — is explored. Although some comparisons were made with similar situations in other parts of the world, the paper focuses on Asia-Europe migration. Although the migration and development debate has acquired a more positive tone, the recognition of the potential of diasporas for development varies by country context and policies have yet to integrate migration and development issues in their frameworks.

Asia and Europe: Transnationalism, multiple linkages and their impact on development

ABSTRACT This Special Issue explores the directions through which we can take research on the migration industries. In this introduction, we review existing research on migration industries to look at how this explores questions on how migration industries foster, assist and constrain migration. In doing so, we argue that these questions have primarily been approached from three different perspectives: structuralist, labour market and mobilities, but these perspectives often speak past rather than to one another. In highlighting how these approaches can work together, the question that the Special Issue explores becomes how do the migration industries function and when/where/how do they intersect with other domains of migration. In highlighting the contributions that each paper in the special issue makes to answering this question, we show how an understanding of the migration industries is not just a research field in itself, but can strengthen our understanding of migration.

Does a provider payment method affect membership retention in a health insurance scheme? a mixed method study of Ghana's capitation payment for primary care

ABSTRACT This paper explores the involvement of migration industry (MI) in the migration system of Indonesia and Malaysia. The two countries share an extensive border and have much in common in culture and history but they are very different in geographical size, population and economic development, the latter being a main cause for labour migration from Indonesia to Malaysia. The changing context of government policies generates new niches for migration services taken up by formal and informal intermediaries, thereby confronting migrants with a varied migration-decision field and thresholds during their migration process. Much of the migration is legal, but a large part of it also takes place outside the control of the national governments. While taking mental processes in migration decision-making as starting point, we analyse how the MI, by way of fostering, facilitating and controlling geographic mobility and localised employment, connects to the production and negotiating of three migration decision thresholds faced by migrants.

Effects of capitation payment on utilization and claims expenditure under National Health Insurance Scheme: a cross-sectional study of three regions in Ghana

Currently, the role of migrants and migrant diasporas in the development of their countries of origin has been more and more in the limelight. It is now widely acknowledged that labor migrants send substantial amounts of remittances back home and that these could have a profound impact on the socio-economic development in the villages, regions and countries of origin. Moreover, it is becoming increasingly clear that over the years migrant diasporas maintain multifarious relations with the regions and countries of origin. These ties can be economic, social, cultural, religious and political in nature. Recent studies (Vertovec and Cohen, 1999; Portes, 2001; NybergSorensen et al., 2002; Haas, 2003) suggest that transnationalism - i.e., migrants being involved in their countries of destination and origin and in different locales aided by improvements in communication and transportation – could be a factor promoting development and social change in the countries of origin. Since labor migration and transnationalism are worldwide phenomena, their effects on development processes call for a comparative approach that takes the different settings into consideration. Also, more studies are required to determine the exact nature of the impacts, i.e., whether the net effects are advantageous, deleterious or mixed for the origin areas, and under which circumstances. In particular, research on the link between migrant diasporas and development from the perspective of developing countries is called for (Hugo, 2003:36). The papers in this special issue originate from an international conference to address these issues. The conference, “Contemporary Migrations in