^arte de Frontenex 39b, CH-1207 Geneva, Switzerland. E-mail: daviddror@socialre.org, johnarmstrong@eircom.net

^*This article incorporates elements from an earlier partial version (Dror et al., 2005a). The calculations presented here differ from previous findings as they are based on a new and much larger set of iterations of the empirical data, and a complete revision of the text, tables, figures and references. Useful comments of four anonymous peer reviewers are gratefully acknowledged.

Abstract

The purpose of this article is to provide a technical discussion of capital loading that "micro health insurance units" (MIUs) must add to the premium to maintain financial sustainability. MIUs offer benefit packages and require prepayment, that is, they create a rudimentary community-based health insurance for poor people in low-income countries. We broke up the 2001 data set of a health insurer containing upward of 1.3 million insureds into 535 "virtual MIUs"; and running 1,005 iterations, we got a data yield of 537,675 virtual MIUs. Capital loading levels increased steeply with decreasing group size and higher confidence levels. The impact of group size remains strong even with groups of 25,000 plus, and is stronger than the impact of changes in confidence levels. We discuss options to correct size-related premium bias through government subsidies, and conclude that reinsurance is cheaper than capital loading and a preferable solution for governments compared to other alternatives.