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Open Access Open Badges Research article

Illness Mapping: a time and cost effective method to estimate healthcare data needed to establish community-based health insurance

Erika Binnendijk1, Meenakshi Gautham1, Ruth Koren2 and David M Dror13*

Author Affiliations

1 Institute of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, Rotterdam, 3000 DR, the Netherlands

2 Felsenstein Medical Research Centre, Tel Aviv University Sackler Faculty of Medicine, Ramat Aviv, Tel Aviv, Israel

3 Micro Insurance Academy, 52B Okhla Industrial Estate Phase III, New Delhi, 110020, India

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BMC Medical Research Methodology 2012, 12:153  doi:10.1186/1471-2288-12-153

Published: 9 October 2012



Most healthcare spending in developing countries is private out-of-pocket. One explanation for low penetration of health insurance is that poorer individuals doubt their ability to enforce insurance contracts. Community-based health insurance schemes (CBHI) are a solution, but launching CBHI requires obtaining accurate local data on morbidity, healthcare utilization and other details to inform package design and pricing. We developed the “Illness Mapping” method (IM) for data collection (faster and cheaper than household surveys).


IM is a modification of two non-interactive consensus group methods (Delphi and Nominal Group Technique) to operate as interactive methods. We elicited estimates from “Experts” in the target community on morbidity and healthcare utilization. Interaction between facilitator and experts became essential to bridge literacy constraints and to reach consensus.

The study was conducted in Gaya District, Bihar (India) during April-June 2010. The intervention included the IM and a household survey (HHS). IM included 18 women’s and 17 men’s groups. The HHS was conducted in 50 villages with1,000 randomly selected households (6,656 individuals).


We found good agreement between the two methods on overall prevalence of illness (IM: 25.9% ±3.6; HHS: 31.4%) and on prevalence of acute (IM: 76.9%; HHS: 69.2%) and chronic illnesses (IM: 20.1%; HHS: 16.6%). We also found good agreement on incidence of deliveries (IM: 3.9% ±0.4; HHS: 3.9%), and on hospital deliveries (IM: 61.0%. ± 5.4; HHS: 51.4%). For hospitalizations, we obtained a lower estimate from the IM (1.1%) than from the HHS (2.6%). The IM required less time and less person-power than a household survey, which translate into reduced costs.


We have shown that our Illness Mapping method can be carried out at lower financial and human cost for sourcing essential local data, at acceptably accurate levels. In view of the good fit of results obtained, we assume that the method could work elsewhere as well.

India; Community based health insurance (CBHI); Micro health insurance; Illness prevalence; Incidence of hospitalization; Illness Mapping