What is a health card worth? An evaluation of an outpatient health insurance product in rural India


In 2009, a pilot project was implemented by CARE Foundation in which low-skilled resident Community Health Workers (CHW) were trained and deployed in 50 villages in Yavatmal in Maharashtra, India, to offer first-level primary and preventive care consultations. The CHWs either made referrals to a doctor in a nearby town, or prescribed another course of action. The CHWs further sold an outpatient health insurance product and a range of preventive products.This paper, by ILO's Microinsurance Innovation Facility, presents the findings of a randomised controlled trial that evaluated the impact of the initiative on the targeted population. It was found that people with the health insurance card that permitted cashless visits to the CHWs had different outcomes compared to people who visited the CHWs without insurance. Households in the treatment group had a higher number of visits to the CHWs, and more referrals to the doctor and to hospitals. It was also found that the insurance only group spent fewer days in the hospital, and spent less out-of-pocket on hospitalisation expenses. The authors’ conclude that insurers as well as government agencies deploying hospitalisation insurance schemes could benefit if the inpatient cover was bundled with outpatient insurance.






Ajay Mahal, Karuna Krishnaswamy, Rupalee Ruchismita, Girish Babu



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