Health  Vol.6 No.11 , May 2014
Community Based Health Insurance in India: Prospects and Challenges
Abstract: The health inequities remain high in India with government and private health expenditures clearly favoring the rich, urban population and organized sector workers and the Out Of Pocket (OOP) spending as high as 80%, afflicting the poor in the worst manner. The focus of the paper is to examine the potential Community Based Health Insurance (CBHI) offers to improve the healthcare access to rural, low-income population and the people in unorganized sector. This is done by drawing empirical evidence from various countries on their experiences of implementing CBHI schemes and its potential for applications to India, problems and challenges faced and the policy and management lessons that may be applicable to India. It can be concluded that CBHI schemes have proved to be effective in reducing the Catastrophic Health Expenditure (CHE) of people. But success of such schemes depends on its design, benefit package it offers, its management, economic and non-economic benefits perceived by enrollees and solidarity among community members. Collaboration of government, NGO’s and donor agencies is very crucial in extending coverage; similarly overcoming the mistrust that people have from such schemes and subsidizing the insurance for the many who cannot pay the premiums are important factors for success of CBHI in India. One of the biggest challenges for the health system is to address the piecemeal approach of CBHI schemes in extending health insurance and inability of such schemes to cover a large number of poor and the unorganized sector workers. Also, there is a need for a stronger policy research to demonstrate: 1) how such schemes can create a larger risk pool, 2) how such schemes can enroll a large number of people in the unorganized sector, 3) the interaction of CBHI schemes with other financing schemes and its link to the health system.
Cite this paper: Purohit, B. (2014) Community Based Health Insurance in India: Prospects and Challenges. Health, 6, 1237-1245. doi: 10.4236/health.2014.611152.

[1]   Gottret, P. and Scheiber, G. (2006) Health Financing Revisited: A Practitioner’s Guide. The World Bank, Washington DC.

[2]   WHO (2000) Who Pays for the Health System? The World Health Report 2000, WHO, Geneva.

[3]   Hsiao, W. (2007) Why Is a Systematic View of Health Financing Necessary? Health Affairs, 26, 950-961.

[4]   NRHM Mission Document (2005-2012).

[5]   Selvaraj, S. (2011) A Critical Assessment of Existing Health Insurance Models in India. Planning Commission of India, New Delhi.

[6]   Ahuja, R. (2004) Health Insurance for Poor. Economic and Political Weekly, 34, 3171-3178.

[7]   Shiva, A.K., Chen, L.C., Mita, C., et al. (2011) Financing Health Care for All: Challenges and Opportunities. The Lancet, 377, 668-679.

[8]   Garg, C. (1998) Equity of Health Sector Financing and Delivery in India: Harvard School of Public Health.

[9]   Peters, D., Yazbeck, A., Sharma, R., Ramana, G., Pritchett, L. and Wagstaff, A. (2002) Better Health Systems for India’s Poor: Findings, Analysis and Options. The World Bank, Washington DC.

[10]   Informal Sector in India: Approaches for Social Security.

[11]   Ministry of Statistics and Programme Implementation.

[12]   Van Damme, W., Van Leemput, L., Por, I., Hardemann, W. and Meessen, B. (2004) Out-Of-Pocket Health Expenditure and Debt in Poor Households: Evidence from Cambodia. Tropical Medicine & International Health, 9, 273-280.

[13]   Devadasan, N., Criel, B., Damme, W.V., Ranson, K. and Stuyft, P.V. (2007) Indian Community Health Insurance Schemes Provide Partial Protection against Catastrophic Health Expenditure. BMC Health Services Research, 7, 43.

[14]   Mahal, A., Karan, A. and Engelau, M. (2010) The Economic Implications of Non-Communicable Disease for India. World Bank, Washington DC.

[15]   Dong, H., Kouyate, B., Cairns, J. and Sauerborn, R. (2005) Inequality in Willingness-To-Pay for Community-Based Health Insurance. Health Policy, 72, 149-156.

[16]   Preker, A., Carrin, G., et al. (2001) Role of Communities in Resource Mobilization and Risk Sharing: A Synthesis Report. World Health Organization, Geneva, 41.

[17]   Benett, S. (2004) The Role of Community-Based Health Insurance within the Health Care Financing System: A Framework for Analysis. Health Policy and Planning, 19, 147-158.

[18]   Sauerborn, R., Nougtara, A., Hien, M. and Diesfeld, H.J. (1996) Seasonal Variations of Household Costs of Illness in Burkina Faso. Social Science and Medicine, 43, 281-290.

[19]   Ranson, M.K. (2002) 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, 613-621.

[20]   Liu, Y. and Hsiao, W.C. (2003) For the People, by the People: Community Financing of Healthcare in Developing Countries. Harvard Health Policy Review, 4, 102-111.

[21]   Allegri, M., Sanon, M. and Sauerborn, R. (2006) To Enroll or Not to Enroll? A Qualitative Investigation of Demand for Health Insurance in Rural West Africa. Social Science & Medicine, 62, 1520-1527.

[22]   Zeller, M. and Sharma, M. (1998) Rural Finance and Poverty Alleviation: Food Policy Report. International Food Policy Research Institute, Washington DC.

[23]   Bennett, S., Creese, A. and Monasch, R. (1998) Health Insurance Schemes for People outside Formal Sector Employment. World Health Organization, Geneva.

[24]   Bhat, R. and Jain, N. (2006) Factors Affecting the Demand for Health Insurance in a Micro Insurance Scheme. Working Paper No. 2006-07-02, India Institute of Management, Ahmadabad.

[25]   Acharaya, A. and Ranson, M.K. (2005) Healthcare Financing for the Poor: Community Based Health Insurance Schemes in Gujarat. Economic and Political Weekly, 40, 4141-4150.

[26]   Sinha, T., Ranson, K., Chatterjee, M., Acharya, A. and Mills, A. (2006) Barriers to Accessing Benefits in a Community-Based Health Insurance Scheme: Lessons Learnt from SEWA Insurance, Gujarat. Health Policy and Planning, 21, 132-142.

[27]   Mathiyazhagan, K. (1998) Willingness to Pay for Rural Health Insurance through Community Participation in India. The International Journal of Health Planning and Management, 13, 47-67.<47::AID-HPM495>3.0.CO;2-I

[28]   Desai, S. (2009) Keeping the “Health” in Health Insurance. Economic and Political Weekly, XLIV, 18-21.

[29]   Ranson, M.K., Sinha, T., Chatterjee, M., Gandhi, F., Jayswal, R., Patel, F., Morris, S.S. and Mills, A.J. (2007) Equitable Utilization of Indian Community Based Health Insurance Scheme among Its Rural Membership: Cluster Randomized Controlled Trial. British Medical Journal, 334, 1282-12783.

[30]   Bärnighausen, T., Liu, Y., Zhang, X. and Sauerborn, R. (2007) Willingness to Pay for Social Health Insurance among Informal Sector Workers in Wuhan, China: A Contingent Valuation Study. BMC Health Services Research, 7, 114.