Microinsurance-low-cost health insurance based on a community, cooperative, or mutual and self-help arrangements-can provide financial protection for poor households and improve access to health care. However, low benefit caps and a low share of premiums paid as benefits-both designed to keep these arrangements in businessperversely limited these schemes' ability to extend coverage, offer financial protection, and retain members. We studied three schemes in India, two of which are member-operated and one a commercial scheme, using household surveys of insured and uninsured households and interviews with managers. All three enrolled poor households and raised their use of hospital services, as intended. Financial exposure was greatest, and protection was least, in the commercial scheme, which imposed the lowest caps on benefits and where income was the lowest. [Health Aff (Millwood). 2009;28(6):1788-98] I nc r e a s i n g awa r e n e s s in India about the value of health insurance has led to a diversity of plans, including "microinsurance." Microinsurance is low-cost health insurance based on a community or cooperative model, as distinct from conventional insurance. Microinsurance units can increase access to health care, 1 improve equality among members, 2 capture additional resources, 3 and promote social protection 4-9 and the development of financial systems. 10 Most of them require reinsurance. 11 Micro health insurance covered an estimated thirty-six million people worldwide in 2006. 12 We report on a study of three microinsurance arrangements operating in two Indian states. The three differ in target membership, benefits, and claims management practices. We identify the strengths and shortcomings of the different approaches as judged by their im- M a r k e t W a t c h

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