Dynamic information asymmetry in micro health insurance: implications for sustainability

Micro health insurance is an important channel for financing health expenditure for low-income people, yet the supply of such programmes lags behind demand because many of them become unsustainable. Using individual-level dynamic data from a micro health insurance programme in Pakistan, this study tests for the existence of information asymmetry (adverse selection and moral hazard) using a series of non-parametric tests so that insurers and policymakers can better understand the underlying reasons that lead to dynamic claim patterns before taking appropriate actions to improve the sustainability of these programmes. The study’s contribution lies in constructing an appropriate method and novel test statistics to detect information asymmetry using dynamic claim data in a multivariate recurrent event model framework. The results show that adverse selection exists widely for a variety of disease types and that moral hazard is only significant for chronic diseases. Furthermore, pregnancy-related claims demonstrate an increasing trend of adverse selection that needs to be addressed with priority. The analysis provides insight into the sustainable provision of micro health insurance to low-income people in developing regions.