The mission of Swayam Shikshan Prayog ('SSP') is to build resilience in low income households in rural India by improving healthcare access and creating an economic safety net through grassroots women’s collectives.
SSP has partnered with Swasth India Services ('SIS') to pilot a Community Health Fund ('CHF') in which a comprehensive health product will be offered. The project envisages implementation of a health insurance product (inpatient care insured and cashless delivery) with an out-patient component delivered through a network of physicians, diagnostic centers and drug dispensing units, coordinated by Community Health Workers ('CHWs'). The overall objective of the project is to provide insurance benefits which are – (i) easily understood and adopted by the end consumers, without most of the inherent complexities of current products in the market (such as exclusions, sub-limits on expenses, waiting periods, etc); (ii) provide a fallback mechanism during catastrophic health events; (iii) reduce the costs of smaller but more frequent health expenses.
Key aspects of the project include:
Member families will pool savings to create a self sustaining CHF.
- The total premium will be collected by the CHF from the members.
- To secure the CHF from high claims, the CHF will procure a group insurance policy from a regular insurance company, using a part of the premium collected
- Remaining part of the premium will be retained by the CHF for self-insurance and running the scheme's operations, including the outpatient component
A hybrid health insurance model will be developed to test its ability to provide:
- Insulation from high cost health events through a group insurance policy and cashless facility for hospital services (up to an annual cover of USD 667 for the whole family)
- Additional value to clients from reduction of 30% in healthcare costs – by providing them access to 50% discount on consultation fees from a network of local physicians and 40-70% discount on the retail price of drugs
- Reduction in disease incidence through quality primary and preventive services
- Quality assurance in health-services delivery through regular quality audits of providers and customer feedback surveys
- The CHF will forge partnerships across the health value chain - insurers, hospitals, doctors, diagnostic labs and pharmacies - with focus on acceptability, affordability and quality and build a robust, low-cost and low-overhead comprehensive health system.
- A network of Community Health Workers (CHWs) will be developed to be front line servicing staff for the CHF, to promote better health, and to develop as grass roots social entrepreneurs.
- In the first 2 year phase of the project, the product will be rolled out in 100 villages in 2 districts in the state of Maharashtra, having a total population of 250,000 – 300,000 people.
Date of last Learning Journey update: November 2011