Community-based health insurance schemes in India: a review

There is an increasing inclination among multinational agencies--including the World Bank, World Health Organization and International Labour Organization--to advocate community-based health insurance (CBHI) schemes as part of a comprehensive solution to improving access for healthcare services in India. This paper reviews the experience of Indian CBHI schemes, their impact on health system goals, such as access to hospitalization and protection from indebtedness, and the factors--particularly scheme design and management--that may contribute to success. The CBHI schemes in India are extremely diverse in terms of their designs, sizes and target populations. While some of the schemes are run by non-governmental organization (NGO) providers, there is an increasing trend towards collaboration with the Government Insurance Company (GIC). In its partnership with NGOs, the GIC seems to have provided favourable group plans compared to the individual Mediclaim and Jan Arogya policies. We have little information on the impact of existing CBHI schemes--most importantly, in terms of access and protection from indebtedness--and even less on factors that make for a successful scheme. This review suggests that there is a demand for health insurance services among the poor. To date, there is little evidence to suggest that these schemes can include the poorest of the poor or improve access to inpatient care. Furthermore, the schemes have done little to address the issue of low/variable quality of healthcare services. Empirically derived data on the existing schemes in India are extremely limited, making this fertile ground for future research.