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Health Policy Plan. 2014 Dec;29(8):960-74. doi: 10.1093/heapol/czt077. Epub 2013 Oct 26.

Enrolment in community-based health insurance schemes in rural Bihar and Uttar Pradesh, India.

Author information

1
Micro Insurance Academy, New Delhi 110020, India, Institute for Human Development, New Delhi 110002, India, Erasmus University, Rotterdam, 3062 PA, The Netherlands, International Institute of Social Studies, Erasmus University, Rotterdam, 2502 LT The Hague, The Netherlands and Georgetown University, PO Box 23689, Doha, Qatar Micro Insurance Academy, New Delhi 110020, India, Institute for Human Development, New Delhi 110002, India, Erasmus University, Rotterdam, 3062 PA, The Netherlands, International Institute of Social Studies, Erasmus University, Rotterdam, 2502 LT The Hague, The Netherlands and Georgetown University, PO Box 23689, Doha, Qatar pradeep@mia.org.in.
2
Micro Insurance Academy, New Delhi 110020, India, Institute for Human Development, New Delhi 110002, India, Erasmus University, Rotterdam, 3062 PA, The Netherlands, International Institute of Social Studies, Erasmus University, Rotterdam, 2502 LT The Hague, The Netherlands and Georgetown University, PO Box 23689, Doha, Qatar.
3
Micro Insurance Academy, New Delhi 110020, India, Institute for Human Development, New Delhi 110002, India, Erasmus University, Rotterdam, 3062 PA, The Netherlands, International Institute of Social Studies, Erasmus University, Rotterdam, 2502 LT The Hague, The Netherlands and Georgetown University, PO Box 23689, Doha, Qatar Micro Insurance Academy, New Delhi 110020, India, Institute for Human Development, New Delhi 110002, India, Erasmus University, Rotterdam, 3062 PA, The Netherlands, International Institute of Social Studies, Erasmus University, Rotterdam, 2502 LT The Hague, The Netherlands and Georgetown University, PO Box 23689, Doha, Qatar.

Abstract

This article assesses insurance uptake in three community-based health insurance (CBHI) schemes located in rural parts of two of India's poorest states and offered through women's self-help groups (SHGs). We examine what drives uptake, the degree of inclusive practices of the schemes and the influence of health status on enrolment. The most important finding is that a household's socio-economic status does not appear to substantially inhibit uptake. In some cases scheduled caste/scheduled tribe households are more likely to enrol. Second, households with greater financial liabilities find insurance more attractive. Third, access to the national hospital insurance scheme Rashtriya Swasthya Bima Yojana does not dampen CBHI uptake, suggesting that the potential for greater development of insurance markets and products beyond existing ones would respond to a need. Fourth, recent episodes of illness and self-assessed health status do not influence uptake. Fifth, insurance coverage is prioritized within households, with the household head, the spouse of the household head and both male and female children of the household head, more likely to be insured as compared with other relatives. Sixth, offering insurance through women's SHGs appears to mitigate concerns about the inclusiveness and sustainability of CBHI schemes. Given the pan-Indian spread of SHGs, offering insurance through such groups offers the potential to scale-up CBHI.

KEYWORDS:

Bihar; Community-based health insurance; Uttar Pradesh; enrolment; health microinsurance; rural India; self-help groups

PMID:
24162838
DOI:
10.1093/heapol/czt077
[Indexed for MEDLINE]

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