• Health insurance

Health insurance

This article in BMC health services research examines two Indian community health insurance (CHI) schemes, ACCORD and SEWA, to determine whether insured households are protected from catastrophic health expenditure (annual hospital expenditure greater than 10 per cent of annual income). The paper finds that in the absence of CHI schemes, patients would have had to pay out of pocket (OOP) payments for their hospitalisation. With the CHI schemes, 67 per cent and 34 per cent of patients did not have to make any OOP payments for their hospital expenses at ACCORD and SEWA, respectively. Both CHI schemes halved the number of households that would have experienced catastrophic health expenditure by covering hospital costs.

Despite this, some households still experienced catastrophic health expenditure due to: low annual income; benefit packages with low maximum limits; exclusion of some conditions from the benefit package; and use of the private sector for admissions. The article concludes that CHI appears to be effective in halving the incidence of catastrophic health expenditure among hospitalised patients. This protection could be further enhanced by improving the design of CHI schemes, especially by increasing the upper limits of benefit packages, minimising exclusions and controlling costs.

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