Beyond Financial Protection: A Comprehensive Framework for Value for Money in Health Insurance for Informal Sector Populations

Background: Traditional conceptions of "value for money" in health insurance are narrowly framed around financial metrics, inadequately capturing the multidimensional nature of value for informal sector populations. Objectives: This paper develops a theoretical framework conceptualizing value for money beyond financial protection to include preference alignment and social capital formation. Methods: We examine trust as a core mathematical variable rather than an environmental factor by analyzing generalizations from community-based health insurance schemes in India, the Philippines, Uganda, Cambodia, Bangladesh, Rwanda, and South Africa. Results: Our framework reveals trust exhibits specific properties including asymmetric response and critical thresholds, and that the Collaborative and Contributive (C&C) model generates distinctive value propositions yielding superior sustainability and willingness-to-pay metrics compared to conventional approaches. Conclusions: This framework reconceptualizes value for vulnerable populations and provides actionable design principles for optimizing insurance value across three dimensions: financial protection, preference alignment, and social capital formation.