Performance of community health insurance in India: findings from empirical studies

Narayanan Devadasan,Wim Van Damme,Patrick Van Der Stuyft,Bart Criel

doi:10.1186/1753-6561-6-s1-p9

Narayanan Devadasan, Wim Van Damme + Show 2 more

Open Access

https://doi.org/10.1186/1753-6561-6-s1-p9

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Abstract

In India, health care is provided by a mix of government and private providers. While the government health services are ostensibly free, in reality, studies have shown that people have to pay for medicines, diagnostics and other procedures. People approaching the private sector usually end up making out-of-pocket payments (OOP). This has two effects- it can be a substantial and inequitable barrier to accessing health services, and among those who access these services, it can result in impoverishment. Health insurance is considered as a protective measure against the harmful effects of OOP. Most of the people in India (and especially the poor) are not covered by health insurance. There is a growing movement of community health insurance (CHI) in India, which covers the poorer sections of the Indian community. However, there is little evidence that CHI is able to improve equitable access quality health care and prevent impoverishment. We present the findings of a study on CHI.

Highlights

In India, health care is provided by a mix of government and private providers
From our initial survey, we found that all community health insurance (CHI) schemes in the country were organised by non-government organisations (NGO)
The schemes can be divided into three broad models – a provider model where the NGO is the organiser, the insurer and the provider of care; an insurer model where the NGO is the organiser and insurer, but purchases care from private hospitals; and the agent model where the NGO is just the organiser and purchases insurance from insurance companies and care from private hospitals

Summary

Introduction

In India, health care is provided by a mix of government and private providers. People approaching the private sector usually end up making out-of-pocket payments (OOP). This has two effects- it can be a substantial and inequitable barrier to accessing health services, and among those who access these services, it can result in impoverishment. Health insurance is considered as a protective measure against the harmful effects of OOP. Most of the people in India (and especially the poor) are not covered by health insurance. There is a growing movement of community health insurance (CHI) in India, which covers the poorer sections of the Indian community. There is little evidence that CHI is able to improve equitable access quality health care and prevent impoverishment.

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