+ Site Statistics
+ Search Articles
+ Subscribe to Site Feeds
EurekaMag Most Shared ContentMost Shared
EurekaMag PDF Full Text ContentPDF Full Text
+ PDF Full Text
Request PDF Full TextRequest PDF Full Text
+ Follow Us
Follow on FacebookFollow on Facebook
Follow on TwitterFollow on Twitter
Follow on LinkedInFollow on LinkedIn

+ Translate

Making health insurance work for the poor: learning from the Self-Employed Women's Association's (SEWA) community-based health insurance scheme in India

Making health insurance work for the poor: learning from the Self-Employed Women's Association's (SEWA) community-based health insurance scheme in India

Social Science & Medicine 62(3): 707-720

How best to provide effective protection for the poorest against the financial risks of ill health remains an unanswered policy question. Community-based health insurance (CBHI) schemes, by pooling risks and resources, can in principal offer protection against the risk of medical expenses, and make accessible health care services that would otherwise be unaffordable. The purpose of this paper is to measure the distributional impact of a large CBHI scheme in Gujarat, India, which reimburses hospitalization costs, and to identify barriers to optimal distributional impact. The study found that the Vimo Self-employed Women's Association (SEWA) scheme is inclusive of the poorest, with 32% of rural members, and 40% of urban members, drawn from households below the 30th percentile of socio-economic status. Submission of claims for inpatient care is equitable in Ahmedabad City, but inequitable in rural areas. The financially better off in rural areas are significantly more likely to submit claims than are the poorest, and men are significantly more likely to submit claims than women. Members living in areas that have better access to health care submit more claims than those living in remote areas. A variety of factors prevent the poorest in rural and remote areas from accessing inpatient care or from submitting a claim. The study concludes that even a well-intentioned scheme may have an undesirable distributional impact, particularly if: (1) the scheme does not address the major barriers to accessing (inpatient) health care; and (2) the process of seeking reimbursement under the scheme is burdensome for the poor. Design and implementation of an equitable scheme must involve: a careful assessment of barriers to health care seeking; interventions to address the main barriers; and reimbursement requiring minimum paperwork and at the time/place of service utilization.

(PDF emailed within 0-6 h: $19.90)

Accession: 004448754

Download citation: RISBibTeXText

PMID: 16054740

DOI: 10.1016/j.socscimed.2005.06.037

Related references

Occupational health of self-employed women workers. Experiences from community based studies of the Self-Employed Women's Association (SEWA). Health for the Millions 1(1): 13-17, 1993

Barriers to accessing benefits in a community-based insurance scheme: lessons learnt from SEWA Insurance, Gujarat. Health Policy and Planning 21(2): 132-142, 2005

Community-based health insurance programmes and the National Health Insurance Scheme of Nigeria: challenges to uptake and integration. International Journal for Equity in Health 13(): 20-20, 2014

Should Governments engage health insurance intermediaries? A comparison of benefits with and without insurance intermediary in a large tax funded community health insurance scheme in the Indian state of Andhra Pradesh. Bmc Health Services Research 15(): 370-370, 2016

Building awareness to health insurance among the target population of community-based health insurance schemes in rural India. Tropical Medicine & International Health 20(8): 1093-1107, 2015

Reduction of catastrophic health care expenditures by a community-based health insurance scheme in Gujarat, India: current experiences and challenges. Bulletin of the World Health Organization 80(8): 613-621, 2002

The association between health insurance status and utilization of health services in rural Northern Ghana: evidence from the introduction of the National Health Insurance Scheme. Journal of Health, Population, and Nutrition 36(1): 42-42, 2017

Willingness to pay for health insurance among rural and poor persons: field evidence from seven micro health insurance units in India. Health Policy 82(1): 12-27, 2006

Social health insurance for the poor: lessons from a health insurance programme in Karnataka, India. Bmj Global Health 3(1): E000582-E000582, 2018

The Association of Marital Status and Offers of Employer-based Health Insurance for Employed Women Aged 27-64: United States, 2014-2015. Nchs Data Brief: 1-8, 2017

The National Health Insurance Scheme in Ghana's Upper West Region: a gendered perspective of insurance acquisition in a resource-poor setting. Social Science & Medicine 122: 103-112, 2015

The Socioeconomic and Institutional Determinants of Participation in India's Health Insurance Scheme for the Poor. Plos One 8(6): E66296-E66296, 2013

Satisfaction with Quality of Care Received by Patients without National Health Insurance Attending a Primary Care Clinic in a Resource-Poor Environment of a Tertiary Hospital in Eastern Nigeria in the Era of Scaling up the Nigerian Formal Sector Health Insurance Scheme. Annals of Medical and Health Sciences Research 3(1): 31-37, 2013

Special Conference Issue: Strategies to Expand Health Insurance for Working Americans || Markets for Individual Health Insurance: Can We Make Them Work with Incentives to Purchase Insurance?. Inquiry - Journal of Health Care Organization, Provision & Financing 38(2): 133-145, 2001

Part-time Work and Men's Health : Results based on Routine Data of a Statutory Health Insurance Scheme. Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz 59(8): 942-949, 2016