Health Policy and Planning Advance Access originally published online on December 22, 2005
Health Policy and Planning 2006 21(2):132-142; doi:10.1093/heapol/czj010
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Original article |
Barriers to accessing benefits in a community-based insurance scheme: lessons learnt from SEWA Insurance, Gujarat
1 Vimo SEWA, Self-Employed Women's Association, Ahmedabad, India, 2 Health Economics and Financing Programme, Health Policy Unit, London School of Hygiene and Tropical Medicine, London, UK,3 SEWA Social Security, Self-Employed Women's Association, Ahmedabad, India and 4 Department of Economics, South Gujarat University, Surat, Gujarat, India
Correspondence: Tara Sinha, Research Coordinator, Vimo SEWA, SEWA Reception Centre, Opposite Victoria Garden, Bhadra, Ahmedabad 380 001, India. Tel: +91 079 26580530; Fax: +91 079 26580508; E-mail: taragsinha{at}yahoo.co.in
This paper seeks to examine barriers faced by members of a community-based insurance (CBI) scheme, which is targeted at poor women and their families, in accessing scheme benefits. CBI schemes have been developed and promoted as mechanisms to offer protection to poor families from the risks of ill-health, death and loss of assets. However, having voluntarily enrolled in a CBI scheme, poor households may find it difficult or impossible to access scheme benefits.
The paper describes the results of qualitative research carried out to assess the barriers faced in accessing scheme benefits by members of the CBI scheme run by the Self-Employed Women's Association (SEWA) in Gujarat, India. The study finds that the members face a variety of different barriers, particularly in seeking hospitalization and in submitting insurance claims. Some of the barriers are rooted in factors outside the scheme's control, such as illiteracy and financial poverty amongst members, and inadequacies of the transportation and health care infrastructure. But other barriers relate to the scheme's design and management, for example, lack of clarity among scheme staff regarding the scheme's rules and processes, and requirements that claimants submit documents to prove the validity of their claims. The paper makes recommendations as to how SEWA Insurance can address some of the identified barriers and discusses the relevance of these findings to other CBI schemes in India and elsewhere.
Key Words: access, community-based insurance, equity, India, inpatient care
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