Publication database

The paper reviews the pilot experiments conducted from 2011 onwards in eight districts across six states to test the provision of outpatient (OP) benefits under RSBY, India’s Social Health Insurance Scheme for low income populations. Administrative data on enrolment, empanelment of care providers and outpatient claims was analysed for the review. The paper also discusses the status of primary care in India and outpatient care provision in similar schemes in other developing nations (Vietnam, Ghana, Indonesia, Philippines and Thailand).

Rashtriya Swasthya Bima Yojna (RSBY) is a programme that needs no introduction. Launched in 2008 to provide secondary care to below poverty line (BPL) households, the scheme has expanded rapidly. Today, it covers nearly 38 million households and is present in 512 districts (out of a total 640) across all 28 states and union territories. This paper analyses key performance indicators (KPIs) for the programme, so as to identify ways of improving the scheme’s performance. 

The study focuses on three KPIs:

Enrolment ratio, measuring the percentage of eligible households enrolled, so as to estimate outreach;
Hospitalization ratio, to estimate utilisation;
Claims ratio, one of the key metrics that determines whether the scheme is profitable for the insurers.

The objective of this study was to conduct a community-based retrospective analysis of primary, secondary and tertiary care utilization over a 12 month period by 5000 urban slum dwellers in the context of an integrated health insurance plan (outpatient and inpatient) that was introduced by Naya Jeevan into Sultanabad (an urban slum in Karachi) during the 2013 calendar year.

Research paper #40 evaluates the financial viability of CARE Foundation’s rural primary-health-care delivery model, which includes an outpatient insurance product. The model is aimed at providing access to affordable primary health care in rural areas. The paper assessed the value proposition of the programme to clients and reviewed the performance of the outpatient insurance product, taking into account the contextual factors affecting the product and the model. Since technology plays an important role and is considered key to contributing greater efficiency, the programme’s use of technology and the impact of this are analysed in detail.  

Financing health for low income households is a significant challenge. Naya Jeevan is trying an innovative approach: in order to make quality health services affordable to low-income workers in Pakistan, it seeks sponsors to pay the majority of the premium on behalf of workers whom they employ or have a business relationship with.

Microfinance institutions have started to bundle their basic loans with other financial services, such as health insurance. Using a randomized control trial in Karnataka, India, Research Paper #37 evaluated the impact on loan renewal from mandating the purchase of actuarially-fair health insurance covering hospitalization and maternity expenses. Bundling loans with insurance led to a 16 percentage point (23%) increase in drop-out from microfinance, as many clients preferred to give up microfinance than pay higher interest rates and receive insurance. There was no adverse selection in insurance enrollment, but only because there was a total absence of demand for health insurance. Further, the decrease in microfinance loan renewal reduced clients' access to credit and had negative impacts on their businesses.

Despite the rapid growth of health microinsurance (HMI) programs, there is little empirical evidence of their distributional consequences. This paper suggests that the concern of HMI leading to regressive transfers from poor to relatively wealthier households is less important than expected based on an imbalanced randomized control trial with a community based HMI programme in rural Maharashtra in India. Below the Poverty Line (BPL) households consume only 66 per cent of non-BPL households’ annual health care expenditures, suggesting that poorer households subsidize wealthier households. Yet, HMI differentially increases BPL households’ health care expenditure by almost USD 3 per month of coverage. Poorer households are also more sensitive to cost reductions in health care and gains in health care are concentrated among them. These findings suggest that HMI narrows the gap in health care consumption among the insured.

The report explores the mobile industry and women in Papua New Guinea (PNG), particularly those living at the bottom of the pyramid (BoP). It investigates the needs and aspirations of the women; what challenges they face in meeting their basic needs; and how mobile services might help to improve their lives and hopes.

Community-based health insurance has been associated with increased hospitalisation in low-income settings, but with limited analysis of the illnesses for which claims are submitted. A review of claims submitted to VimoSEWA, an inpatient insurance scheme in Gujarat, India, found that fever, diarrhoea and hysterectomy, the latter at a mean age of 37 years, were the leading reasons for claims by adult women. The paper compared the morbidity, outpatient treatment-seeking and hospitalisation patterns of VimoSEWA-insured women with uninsured women.