Renewing membership in three community-based health insurance schemes in rural India

Low renewal rate is a key challenge facing the sustainability of Community-based Health Insurance (CBHI) schemes. While there is a large literature on initial enrolment into such schemes, there is limited evidence on the factors that impede renewal. This paper uses longitudinal data to analyse what determines renewal, both one and two years after the introduction of three CBHI schemes, which have been operating in rural Bihar and Uttar Pradesh since 2011. We find that initial scheme uptake is about 23-24 % and that two years after scheme operation, only about 20 % of the initial enrolees maintain their membership. A household’s socio-economic status does not seem to play a large role in impeding renewal. In some instances, a greater understanding of the scheme boosts renewal. The link between health status and use of health care in maintaining renewal is mixed. The clearest effect is that individuals living in households that have received benefits from the scheme are substantially more likely to renew their contracts. We find that having access to a national health insurance scheme is not a substitute for the CBHI. We conclude that the low retention rates may be attributed to limited benefit packages, slow claims processing times and the gaps between the amounts claimed and amounts paid out by insurance

How far does a big push really push?

BRAC implemented the Challenging the Frontiers of Poverty Reduction: Specially Targeted Ultra-Poor (CFPR) program in 2002 to mitigate ultra-poverty in the poorest districts of Bangladesh, providing multifaceted support in the form of asset-transfer, food-stipends, education, healthcare and social support for two years. Utilizing a four-round panel data spanning 9 years and combining regression and propensity score weighting, we evaluate CFPR’s short and long term impact on income, employment, social status, food security and asset ownership. While remarkable effects of CFPR are evident in short and medium-term (up to 6 years since baseline), longer-term effects (up to 9 years) are smaller. The latter happens due to a variety of factors including faster catch-up by the control group, due partly to various new interventions by state and non-state sectors. We see a shift from begging, working as maids and day-laboring to entrepreneurial activities in the short and medium term, but many CFPR households revert back to their baseline employment by 2011. Analyses of the heterogeneity of effects across baseline employment and gender of the household-head reveal greater long-term impact on per-capita income for entrepreneurs and greater short-term impact for female-headed households. Overall, despite the deceleration of the effects in the long run, the program was able to successfully bring its participants out of ultra-poverty and had important demonstration effects

Healthcare seeking behavior among self-help group households in rural Bihar and Uttar Pradesh

Abstract Background: In recent years, supported by non-governmental organizations (NGOs), a number of communitybased health insurance (CBHI) schemes have been operating in rural India. Such schemes design their benefit packages according to local priorities. This paper examines healthcare seeking behaviour among self-help group households with a view to understanding the implications for the benefit packages offered by such schemes. Methods: We use cross-sectional data collected from two of India’s poorest states and estimate an alternativespecific conditional logit model to examine healthcare seeking behaviour. Results: We find that the majority of respondents do access some form of care and that there is overwhelming use of private providers. Non-degree allopathic providers (NDAP) also called rural medical practitioners are the most popular providers. In the case of acute illnesses, proximity plays an important role in determining provider choice. For chronic illnesses, cost of care influences provider choice. Conclusion: Given the importance of proximity in determining provider choice, benefit packages offered by CBHI schemes should consider coverage of transportation costs and reimbursement of foregone earnings

Healthcare Seeking Behavior among Self-help Group Households in Rural Bihar and Uttar Pradesh, India

In recent years, supported by non-governmental organizations (NGOs), a number of demand-driven community-based health insurance (CBHI) schemes have been functioning in rural India. These CBHI schemes may design their benefit packages according to local priorities. In this paper we examine healthcare seeking behavior among self-help group households, with a view to understanding the implications for benefit packages offered by such schemes. This study is based on data from rural locations in two of India’s poorest states.1 We find that the majority of respondents do access some form of care and that there is overwhelming use of private services. Within private services, non-degree allopathic providers (NDAP) also called rural medical practitioners account for a substantial share and the main reason to access such unqualified providers is their proximity. The direct cost of care does not appear to have a bearing on choice of provider. Given the importance of proximity in determining provider choices, several solutions could be foreseen, such as mobile medical tours to villages, and/or that insurance schemes consider coverage of transportation costs and reimbursement of foregone earnings

An Empirical Study for Responsibility Commitment of Japanese White-collar

Abstract Background: In recent years, supported by non-governmental organizations (NGOs), a number of communitybased health insurance (CBHI) schemes have been operating in rural India. Such schemes design their benefit packages according to local priorities. This paper examines healthcare seeking behaviour among self-help group households with a view to understanding the implications for the benefit packages offered by such schemes. Methods: We use cross-sectional data collected from two of India’s poorest states and estimate an alternativespecific conditional logit model to examine healthcare seeking behaviour. Results: We find that the majority of respondents do access some form of care and that there is overwhelming use of private providers. Non-degree allopathic providers (NDAP) also called rural medical practitioners are the most popular providers. In the case of acute illnesses, proximity plays an important role in determining provider choice. For chronic illnesses, cost of care influences provider choice. Conclusion: Given the importance of proximity in determining provider choice, benefit packages offered by CBHI schemes should consider coverage of transportation costs and reimbursement of foregone earnings