The landscape of community health insurance in India: An overview based on 10 case studies

Devadasan, Narayanan; Ranson, Kent; Damme, Wim Van; Acharya, Akash; Criel, Bart

doi:10.1016/j.healthpol.2005.10.005

Cited by 86 publications

(69 citation statements)

References 11 publications

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“…Studies of CHI introduced in some other countries in Asia and Africa suggest that they help increase access to healthcare for lowincome populations, and reduce OOP expenditure for health (Jakab and Krishnan 2001). Since they are based on the principle of social solidarity, CHIs also tend to be better accepted by local populations (Ahuja and Narang 2005;Bhat and Saha 2004;Devadasan et al 2006). …”

Section: Community-based Health Insurance Schemes (Chi)mentioning

confidence: 99%

“…In India, over 115 CHI schemes have been initiated by local NGOs in support of broader development programs (Aggarwal 2010;Michielsen et al 2011;Devadasan et al 2006). One of the most prominent and long-standing CHIs was launched in India in 1992 by the Self-Employed Women's Association (SEWA; Ranson et al 2007).…”

Section: Community-based Health Insurance Schemes (Chi)mentioning

confidence: 99%

“…On the other hand, the private sector has been thriving, providing 80% of outpatient and 60% of inpatient care (Sharma 2015). Even the poorest and least educated people in both rural and urban settings consult private practitioners more than government practitioners and spend about twice as much on treatment from them than from government practitioners (Bhatia and Cleland 2001;Devadasan et al 2006;Purohit and Siddiqui 1994;Madhukumar, Sudeepa, and Gaikwad 2012).…”

Section: Introductionmentioning

confidence: 99%

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Health insurance in India: what do we know and why is ethnographic research needed

Ahlin

Nichter

Pillai

2016

Anthropology & Medicine

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The percentage of India's national budget allocated to the health sector remains one of the lowest in the world, and healthcare expenditures are largely out-of-pocket (OOP). Currently, efforts are being made to expand health insurance coverage as one means of addressing health disparity and reducing catastrophic health costs. In this review, we document reasons for rising interest in health insurance and summarize the country's history of insurance projects to date. We note that most of these projects focus on in-patient hospital costs, not the larger burden of out-patient costs. We briefly highlight some of the more popular forms that government, private, and community-based insurance schemes have taken and the results of quantitative research conducted to assess their reach and cost-effectiveness. We argue that ethnographic case studies could add much to existing health service and policy research, and provide a better understanding of the life cycle and impact of insurance programs on both insurance holders and healthcare providers. Drawing on preliminary fieldwork in South India and recognizing the need for a broad-based implementation science perspective (studying up, down and sideways), we identify six key topics demanding more in-depth research, among others: (1) public awareness and understanding of insurance; (2) misunderstanding of insurance and how this influences health care utilization; (3) differences in behavior patterns in cash and cashless insurance systems; (4) impact of insurance on quality of care and doctor-patient relations; (5) (mis)trust in health insurance schemes; and (6) health insurance coverage of chronic illnesses, rehabilitation and OOP expenses.

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Section: Community-based Health Insurance Schemes (Chi)mentioning

confidence: 99%

Section: Community-based Health Insurance Schemes (Chi)mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Health insurance in India: what do we know and why is ethnographic research needed

Ahlin

Nichter

Pillai

2016

Anthropology & Medicine

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“…Public spending on health care in India amounts to less than 100 INR (around 3 US $) per capita per year. Furthermore, more than 80% of government budgets are earmarked for salaries, leaving very little funds for drugs and other consumables (Devadasan et al, 2004). The per capita government health expenditure in Kerala has been among the highest of any Indian state (Garg, 1998).…”

Section: Policy Implicationsmentioning

confidence: 99%

“…Increasing income inequalities and growing private health care sectors- without corresponding investment in public services or insurance coverage-limit access to affordable care and contribute to the impoverishment of vulnerable populations (Russell, 1996;McDade and Adair, 2001;Devadasan et al, 2004).…”

Section: Introductionmentioning

confidence: 99%

Affording what's free and paying for choice: comparing the cost of public and private hospitalizations in urban Kerala

Lévesque

Haddad

Narayana

et al. 2007

Health Planning & Management

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The effect of community engagement on healthcare utilization and health insurance enrollment in Ghana: Results from a randomized experiment

Duku¹,

Nketiah‐Amponsah

Fenenga

et al. 2022

Health Economics

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Health insurance enrollment in many Sub‐Saharan African countries is low, even with highly subsidized premiums and exemptions for vulnerable populations. One possible explanation is low service quality, which results in a low valuation of health insurance. Using a randomized control trial in 64 primary health care facilities in Ghana, this study assesses the impact of a community engagement intervention designed to improve the quality of healthcare and health insurance services on households living nearby the facilities. Although the intervention improved the medical‐technical quality of health services, our results show that households' subjective perceptions of the quality of healthcare and insurance services did not increase. Nevertheless, the likelihood of illness and concomitant healthcare utilization reduced, and especially households who were not insured at baseline were more likely to enroll in health insurance. The results show that solely increasing the technical quality of care is not sufficient to increase households' subjective assessments of healthcare quality. Still, improving technical quality can directly contribute to health outcomes and further increase health insurance coverage, especially among the previously uninsured.

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The landscape of community health insurance in India: An overview based on 10 case studies

Cited by 86 publications

References 11 publications

Health insurance in India: what do we know and why is ethnographic research needed

Health insurance in India: what do we know and why is ethnographic research needed

Affording what's free and paying for choice: comparing the cost of public and private hospitalizations in urban Kerala

The effect of community engagement on healthcare utilization and health insurance enrollment in Ghana: Results from a randomized experiment

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