Two generations of top-down decisions on health financing systems have produced very modest results for poor people, poor countries or indeed for the major donors/funders. In most developing countries, including India, the lion’s share of health spending is made out of pocket. Impoverishment, low access – especially for weaker segments of the population such as women and children – and thus bad health status are consequences. Health insurance has the potential to remedy or at least reduce the severe consequences of unforeseen health care expenditures. Recently, a growing number of community based health insurance (CBHI) schemes emerge in India and other developing countries. It is expected that CBHI can (i) help mobilizing additional resources for health financing, (ii) provide financial protection and (iii) increase access to health care and hence ultimately the health status of the rural population. Community based health insurance represent the highest hope for extension of insurance amongst the poor, drawing on experience of many western countries and Japan. However, in order to make use of the scarce resources available and build systems offering value to the poor, it is important to have a detailed and evidence based understanding on how to build an efficient and responsive CBHI-system. This proposed project sets out to close the knowledge gap on aspects important for the successful implementation of CBHI. It does so through a set of controlled field experiments through which CBHI is implemented in villages of three states of India. Rigorous longitudinal research documents the learning and makes it available for replication elsewhere. We apply quantitative research along with in depth qualitative research and spatial data. It is the project’s overall objective to: Use affordable, responsive and inclusive Community Based Health Insurance to increase: (i) Equitable access to healthcare and (ii) Financial protection.
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