Providing guidelines to set up sustainable community-based health insurance schemes
This paper aims to examine whether it is possible to operate sustainable health insurance in the informal sector in rural Nepal without premium subsidies. It also discusses the useful role of communities in the self-governance of insurance. The paper presents two voluntary and contributory community-based health insurance (CBHI) schemes that were piloted in the country. These were the Saubhagya scheme and the Sanjeevni scheme, launched in 2011 in two different districts of Nepal. The paper analyzes the operations of these two CBHI schemes from 2011 until 2013. It covers the following sections in detail:
Data and methods used in the study;
Four staged implementation process of the model, which includes: initiating, involving, launch, and post-launch;
Results from analysis of the two CBHI schemes with a focus on nine performance indicators including willingness to pay, benefit package design and pricing, membership in the schemes, loss ratio, value for money, and members’ experience of the claims process;
Discussion of the results and recommendations for sustainable operations and scaling of CBHI schemes to be implemented in the future.