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The role of community health insurance (CD)

By: Debnath, Kanish.
Material type: materialTypeLabelBookPublisher: Ahmedabad Indian Institute of Management Ahmedabad 2016Description: 120 p.Subject(s): Financial inclusion | Health insuranceDDC classification: TH 2016-06 Summary: ABSTRACT Financial inclusion has become a major imperative for development of rural regions and elimination of poverty. Within India, several attempts at financial inclusion have been made, but these efforts have remained mostly unsuccessful and regionally uneven. It appears that financial inclusion, which must be associated with the delivery of credit, savings and insurance services, has remained imperfect on ground because of major impetus given to a ‘credit only’ or a ‘credit first’ approach. This happens because in the absence of affordable healthcare facilities or health insurance, ill health gets extended and often culminates into capacity failure. Given that a potent solution is hardly achievable through the market or government forces, it is argued that community health insurance schemes can take better care of the health of insured households through a judicious mix of ex ante preventive care and ex post curative care even in rural and semi-urban regions. If community run programs can become self-sustained, financial inclusion can be perfected. However, the literature unequivocally and emphatically asserts that the demand for health insurance among microfinance clients is absent. In order to disprove this non-exceptionable statement, this study purposively selects one community organisation – ‘Annapurna Pariwar’, whose health insurance policy has been operational for more than 12 years and now has more than 120,000 insured members and seeks to answer three questions – (a) can community health insurance become self-sustainable? (b) how can a community organisation improve its insurance enrolment? and (c) does insurance membership improve household status? Through a detailed analysis of the organisation, this study finds that community insurance schemes can become manageable if the demand for it is stable and predictable, and this demand can be improved with time by having proper institutional norms and claim handling processes in place. Finally, this study also finds the ameliorating effect of insurance to health shocks faced by the household. These results therefore have major implications for health insurance practice and also hold the guiding light for perfecting financial inclusion. Approved by Thesis Advisory Committee Professor Samar K. Datta, Professor Ravindra H. Dholakia, Professor Arnab K. Laha Professor Vaibhav Bhamoriya
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Thesis (FPM) Vikram Sarabhai Library
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Reference TH 2016-06 (Browse shelf) Not for Issue CD002462

TABLE OF CONTENTS

1. Financial Inclusion is elusive without Community Health Insurance 1
1.1. Financial inclusion in the Indian context 1
1.2. The importance of maintaining good health 3
1.3. Health status, healthcare facilities and healthcare financing 5
1.4. Peculiar characteristics of health and healthcare services 7
1.5. Highlighting features of Community Health Insurance programs 12
1.6. Discussion of the research gap 15
1.7. Introducing the selected organisation – ‘Annapurna Pariwar’ 16
2. Research Methodology 21
2.1. Dyadic relationship between an insured household and the community insurer 21
2.2. Empirical models to answer the research questions 22
2.3. Methods employed for Study 1 25
2.4. Methods employed for Study 2 25
2.5. Methods employed for Study 3 25
2A.1: Names of different databases and their functionality 26
3. Can Community Health Insurance become self-sustainable? 27
3.1. Introduction to study 1 27
3.2. Examining the health insurance program of Annapurna Pariwar 28
3.3. Performance indicators 36
3.4. Social performance 43
3.5. Predicting growth of insured members and funds 44
3.6. Conclusion 45
3A.1: Fit plots for regressed variables 46
4. How can a community organisation improve its insurance enrolment? 47
4.1. Introduction to study 2 47
4.2. Granger causality and co-integration tests 50
4.3. Predicted fit of a time series autoregressive model 51
4.4. Predicted fit of moving-average and autoregressive panel models 53
4.5. Conclusion 54
4A.1: Summary statistics for all 7 branches 55
4A.2: Dickey Fuller and Johansen Cointegration tests 57
4A.3: Granger-Causality Wald tests 64
4A.4: Series autocorrelation tests 65
4A.5: Fit statistics for branch-wise time series autoregressive models 69
4A.6: Fit statistics for moving-average and autoregressive panel models 76
5. Does insurance membership improve household status? 77
5.1. Introduction to study 3 77
5.2. Results of unbalanced ANOVA using GLM 79
5.3. Predicted fit of Panel models with random and fixed error structures 80
5.4. Conclusion 83
5A.1: Summary statistics for all 4 panels across years 84
5A.2: Control and Treatment group characteristics 87
5A.3: Tests for suitability of different panel models 88
5A.4: Fit statistics of suitable models for panel 1 89
5A.5: Fit statistics of suitable models for panel 2 92
5A.6: Fit statistics of suitable models for panel 3 95
5A.7: Fit statistics of suitable models for panel 4 98
6. Summary and Recommendations 101
6.1. Summary of findings 101
6.2. Limitations and future directions 104
6.3. Recommendations for Insurance Corporations 105
6.4. Recommendations for Policy Makers 105
6.5. Recommendations for Microfinance Institutions 106
6.6. Concluding remarks 106
References 109

ABSTRACT

Financial inclusion has become a major imperative for development of rural regions and elimination of poverty. Within India, several attempts at financial inclusion have been made, but these efforts have remained mostly unsuccessful and regionally uneven. It appears that financial inclusion, which must be associated with the delivery of credit, savings and insurance services, has remained imperfect on ground because of major impetus given to a ‘credit only’ or a ‘credit first’ approach. This happens because in the absence of affordable healthcare facilities or health insurance, ill health gets extended and often culminates into capacity failure. Given that a potent solution is hardly achievable through the market or government forces, it is argued that community health insurance schemes can take better care of the health of insured households through a judicious mix of ex ante preventive care and ex post curative care even in rural and semi-urban regions. If community run programs can become self-sustained, financial inclusion can be perfected. However, the literature unequivocally and emphatically asserts that the demand for health insurance among microfinance clients is absent. In order to disprove this non-exceptionable statement, this study purposively selects one community organisation – ‘Annapurna Pariwar’, whose health insurance policy has been operational for more than 12 years and now has more than 120,000 insured members and seeks to answer three questions – (a) can community health insurance become self-sustainable? (b) how can a community organisation improve its insurance enrolment? and (c) does insurance membership improve household status? Through a detailed analysis of the organisation, this study finds that community insurance schemes can become manageable if the demand for it is stable and predictable, and this demand can be improved with time by having proper institutional norms and claim handling processes in place. Finally, this study also finds the ameliorating effect of insurance to health shocks faced by the household. These results therefore have major implications for health insurance practice and also hold the guiding light for perfecting financial inclusion.

Approved by Thesis Advisory Committee

Professor Samar K. Datta,
Professor Ravindra H. Dholakia,
Professor Arnab K. Laha
Professor Vaibhav Bhamoriya

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