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Bringing “Health” into Health Insurance: Evidence for a Converged Approach

About the Project
Project start date: 
Dic 2008
3.5 years
País de operaciones: 
Project Thematic Focus: 
Insitutional models and business processes

Project Basics

The Self Employed Women’s Association (SEWA) is an Indian trade union registered in 1972 which today has over 1.3 million members in 9 states of India.  SEWA members are poor women workers in the informal economy, who comprise agricultural labour, service providers, home-based workers and vendors.  Since 1992, SEWA has offered a composite insurance product (life, hospitalization, accident, and asset  insurance) known as VimoSEWA (SEWA insurance) for women and their families in India.

The VimoSEWA experience confirms a high demand by clients for protection against the costs for prevention and treatment of illness.  Over 90% of VimoSEWA’s claims are for illness.  More specifically, the data indicate that at least one-third of these claims result from preventable acute illnesses such as malaria, gastroenteritis and water-borne disease that, if treated early on, should not require hospitalization.  Unnecessary hospitalization results in loss of income and assets for the poor and negatively affects health.  Furthermore, fewer hospitalizations can improve the viability of insurance by reducing claims expenses.

VimoSEWA believes that preventive health information, access to immediate treatment, and outpatient health care services can reduce the number of patients hospitalized for common illnesses, resulting in savings for families who incur avoidable out of pocket expenses as well as for the insurance program.  The project aims to test if implementing targeted community health education and referral on common illness has an effect on insurance claims, health-related expenditure and health-seeking behaviour.

The project will be implemented in three stages.  In the first phase, VimoSEWA will review health claims in Ahmedabad city and district to identify patterns that may influence health-seeking behaviour and incidence of primary illness, including geographic location, population demographics, average cost of illness, and choice of healthcare provider.  In addition, a baseline survey of insured households will be conducted.  VimoSEWA hopes that the information will provide insight into healthcare preferences based on the illness and at which point in the continuum of an illness that insurance is utilized.

In the second phase, VimoSEWA will develop specific health interventions to target common illnesses including community-based group health education, doorstep primary service by community health workers (CHWs), linkages with outpatient services, provision of herbal medicines, and referral to government services.  Finally, during phase three, the effectiveness of the interventions will be tested.  A sample of 1960 households from two wards of Ahmedabad city and 2 areas of Ahmedabad district will be followed during the study period.  Control groups of insured and non-insured households will receive SEWA’s ongoing health services, but no targeted information or special educational materials on commonly claimed for illnesses.

At the end of the study, statistical analyses of the claim database and household surveys and interviews with claimants and non-claimants will provide information on the impact of health education delivered by community health workers on both the insured and uninsured, as well as how insurance affects health seeking behaviour. Results from the study will inform VimoSEWA’s approach in all program areas in Gujarat and the six other states of India. Project leaders believe that the results will have far reaching effects with important information for health insurance providers who focus on providing to poor households throughout the world. 

 Date of last Learning Journey update: August 2011