The consequences of health insurance for the informal sector: two non-governmental, non-profit schemes in gujarat

THE CONSEQUENCES OF HEALTH INSURANCE FOR THE INFORMAL SECTOR: TWO NON-GOVERNMENTAL, NON-PROFIT SCHEMES IN GUJARAT CONTENTS * Abstract * Citation * Links ABSTRACT Policy makers generally see

community-based health insurance (CBHI) as a means of improving access to expensive medical care, particularly among the poor, and preventing indebtedness secondary to medical expenditures.

However, there is a paucity of empirical evidence on the impact of CBHI, and how its impact is influenced by a scheme's design, management and context. This research examined the

economic and social impact of two CBHI schemes in Gujarat, India, and explored potential determinants of impact. A case study approach was employed. Data were collected using a variety of

methodologies: a cross-sectional household survey, review of insurance scheme utilisation data, focus group discussions, and in-depth interviews. The CBHI schemes had achieved minor

successes. Both provided financial protection to those who actually used the schemes and one of the schemes was successful in including the poor. These successes, however, were overwhelmed

by very low rates of utilisation. Demand for membership in the schemes was determined in part by their strong links with larger parent organisations a dairy co-operative and a worker's

union and by other services that were packaged with the health insurance. Factors responsible for low rates of health insurance utilisation included a lack of awareness among members of the

schemes and their benefits, and perceived problems with the cost, quality and/or accessibility of benefits provided. The findings support a cautious approach among those wishing to foster

CBHI in developing countries. Schemes should not be expected to contribute rapidly to broad health system goals. Consistent with past research on CBHI, this study finds that scheme design

and management are of utmost importance in determining whether or not the scheme will have the desired impact. Specific areas are identified where government might intervene to optimise the

impact of a CBHI scheme. CITATION Ranson, M. The consequences of health insurance for the informal sector: two non-governmental, non-profit schemes in Gujarat. (2004) LINKS The consequences

of health insurance for the informal sector: two non-governmental, non-profit schemes in Gujarat UPDATES TO THIS PAGE Published 4 December 2006 Contents