The amount a person is capable of paying in order to benefit from insurance coverage. A person's ability to pay is always equal to or greater than his or her willingness to pay. [ILO-STEP, 144]
See: willingness to pay

    Refers to the possibility that exists for people to make use of health care or health services. In order for everyone to enjoy access to health care or health services, steps must be taken to remove barriers, particularly economic, financial or cultural barriers, as well as those relating to the supply of health care when the latter is either non-existent or overburdened (and therefore inadequate to meet demand). Setting up a health micro-insurance scheme facilitates access to health care and services by removing certain financial barriers, but does not always resolve problems of geographic or cultural accessibility.

Geographic accessibility
Access to health care of acceptable quality by the inhabitants of a village may be limited by the distance between the village and health care providers, or by a lack of organized transport.

Cultural accessibility
Access to health care and the selection of treatment options may, to some extent, be influenced by social perceptions, attitudes towards illness and maternity, or family and community strategies for dealing with illness and maternity. [ILO-STEP, 144]

   Refers to the period for which financial statements are prepared. The accounting period is usually determined by law and, in many cases, corresponds to one calendar year. [ILO-STEP, 144]

   Transfers are recorded at the time of the events that create the related claims and liabilities, not at the time when the actual payment is made (see under cash basis). For example, if, for whatever reason, the old age pension for the month of December 2002 is paid only in January 2003, the year recorded on an accrual basis would be 2002 while the data recorded would be 2003 on a cash basis. [ILO, 694]
See: cash basis

   Insured individuals who have made at least one contribution or on whose behalf at least one contribution has been made during the reporting period. [ILO, 694]

   Cash payments by employers to social security schemes to secure entitlement to social benefits for employees, former employees and their dependants. [ILO, 694]

   Any management and administrative expenditure incurred by the scheme directly responsible for the provision of social protection benefits, such as salaries, or the costs of running an office. [ILO, 694]

   A phenomenon according to which persons with a greater-than-average risk of illness or maternity enrol in a health micro-insurance scheme in a higher proportion than that of their share of the target population and/or choose the highest levels of coverage. When individuals have no say about whether to be insured or at what level of coverage, adverse selection does not exist. Such is the case when membership is automatic and schemes offer a single level of coverage. The existence of adverse selection may jeopardize a scheme's financial viability given that benefit-related expenses risk exceeding forecasts, since they are based on estimates of consumption for the overall target population. [ILO-STEP, 144]
Synonym: anti-selection

   Persons who are insured with the scheme. This includes persons who are active contributors and persons who have not made any contributions or on whose behalf no contributions have been made during the reporting period but who are still protected by the scheme and would give rise to a benefit should a contingency arise. [BIT, 694]
Synonym: registered persons

   An agreement concluded between a health micro-insurance scheme and a health care provider that specifies the services to be covered, fees to be applied, standards of quality to be respected and the amount and methods of payment for services rendered. Such agreements must enable the persons protected to enjoy quality health care at a pre-established and reasonable price. [ILO-STEP, 144]

   Synonym: capitation

   A financial arrangement to provide an income for a specified number of years or for the remaining lifetime of an individual or a group of individuals out of an accumulated lump sum. The lump sum is divided by the present value of a pension of 1 Currency Unit to be paid during the remaining lifetime or a defined period. [ILO, ISSA, 630]

   See: adverse selection

   A group of persons who voluntarily join together for a particular purpose or to defend common interests. Contrary to commercial enterprises, associations are operated on a non-profit basis.
Examples: Associations of producers, consumers, human rights defenders; sports or cultural associations, etc. [ILO-STEP, 144]

    Context: utilization of health services

   A characteristic of an individual who does not like uncertainty. The greater an individual's aversion to risk, the more he or she will be willing pay in order to obtain insurance coverage. [ILO-STEP, 144]