Reconciling research and implementation in micro health insurance experiments in India: study protocol for a randomized controlled trial

Trials

David M Dror¹  Ralf Radermacher²  Ellen Van de Poel¹  Pradeep Panda²  Conor Doyle² 

[1] Institute of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands;Micro Insurance Academy, 246 Sant Nagar, East of Kailash, New Delhi 110065, India

关键词: randomised trial;    financial protection;    healthcare utilisation;    community based;    Micro insurance;   

Others  :  1095825
DOI  :  10.1186/1745-6215-12-224

 received in 2011-08-02, accepted in 2011-10-11,  发布年份 2011

【 摘 要 】

Background

Microinsurance or Community-Based Health Insurance is a promising healthcare financing mechanism, which is increasingly applied to aid rural poor persons in low-income countries. Robust empirical evidence on the causal relations between Community-Based Health Insurance and healthcare utilisation, financial protection and other areas is scarce and necessary. This paper contains a discussion of the research design of three Cluster Randomised Controlled Trials in India to measure the impact of Community-Based Health Insurance on several outcomes.

Methods/Design

Each trial sets up a Community-Based Health Insurance scheme among a group of micro-finance affiliate families. Villages are grouped into clusters which are congruous with pre-existing social groupings. These clusters are randomly assigned to one of three waves of implementation, ensuring the entire population is offered Community-Based Health Insurance by the end of the experiment. Each wave of treatment is preceded by a round of mixed methods evaluation, with quantitative, qualitative and spatial evidence on impact collected. Improving upon practices in published Cluster Randomised Controlled Trial literature, we detail how research design decisions have ensured that both the households offered insurance and the implementers of the Community-Based Health Insurance scheme operate in an environment replicating a non-experimental implementation.

Discussion

When a Cluster Randomised Controlled Trial involves randomizing within a community, generating adequate and valid conclusions requires that the research design must be made congruous with social structures within the target population, to ensure that such trials are conducted in an implementing environment which is a suitable analogue to that of a non-experimental implementing environment.

【 授权许可】

   
2011 Doyle et al; licensee BioMed Central Ltd.

【 图 表 】

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