ORGANIZATIONAL ACTION COMPONENT

Suggesting steps to improve the acceptability of the

healthcare security scheme KRUPA

Faculty Guide: Prof. D P Misra

Reporting Officer: Mr. Pragnesh Gor

Submitted by
Manoj Prabhakar (25024)
Suyash Rai (25048)

Host Organization
Charutar Arogya Mandal

OTS PRM 2004-06

Institute of Rural Management, Anand

August, 2005
Table of contents:

Topic Page
INTRODUCTION TO COMMUNITY HEALTH INSURANCE 1
INTRODUCTION TO THE SCHEME 6
MAIN PURPOSE OF THE STUDY 11
THE OBJECTIVES OF THE STUDY 11
DECISION PROBLEM 12
RESEARCH PROBLEM 12
SCOPE OF THE STUDY 12
PRE-STUDY PREPARATION - ANALYSIS OF EARLIER STUDIES AND
OBSERVATIONS
12
METHODOLOGY 17
FINDINGS FROM THE SURVEY
Findings from the survey of individual community members
22
Findings from schools 46
46
Findings from companies
47
Summary of the main findings from the field study
STUDY OF OTHER SCHEMES AND SUGGESTIONS:
Provider model
49
The other two models of Community Health Insurance 58

ANNEXURE 60
REFERENCE 61

List of tables:
No Title Page
1 Yearly subscription fee and corresponding indoor patient expense coverage 8
2 One-time subscription rates 9
3 Morbidity profile of urban households 14
4 Morbidity profile of rural households 14
5 Healthcare seeking preference for Non-KRUPA respondents 23
6 Reasons for not preferring SKH (for Non-KRUPA) 23
7 Healthcare seeking preference for urban poor Non-KRUPA respondents 24
8 Reasons for not preferring (for urban poor Non-KRUPA respondents) 24
9 Healthcare seeking preference for urban non- poor Non-KRUPA
respondents 25
10 Reasons for not preferring (for urban non- poor Non-KRUPA respondents) 25
11 Healthcare seeking preference for rural non-poor Non-KRUPA respondents 26
12 Reasons for not preferring (for rural non- poor Non-KRUPA respondents) 26
13 Healthcare seeking preference for rural poor non-KRUPA respondents 27
14 Reasons for not preferring (for rural poor Non-KRUPA respondents) 27
15 Perception about the hospital (Urban poor non-KRUPA) 28
16 Perception about the hospital (Urban non-poor non-KRUPA) 28
17 Perception about the hospital (rural poor non-KRUPA) 29
18 Perception about the hospital (rural non-poor non-KRUPA) 29
19 Reasons for buying insurance (Non-KRUPA) 30
20 Reasons for not becoming members (Non-KRUPA) 31
21 Perceptions about KRUPA 32
22 Healthcare seeking preference for non-renewing members 34
23 Reasons for not preferring (Non-renewing members) 34
24 Perception about the hospital (Non-renewing members) 35
25 Reasons for buying an insurance policy (Non-renewing members) 35
26 Perception about the scheme (non-renewing members) 36
27 Experience while availing benefits (non-renewing members) 36
28 Reasons for leaving the scheme (non-renewing members) 37
29 Preference of health-service providers (renewing members) 38
30 Perception about the hospital (renewing members) 38
31 Reasons for buying insurance (renewing members) 39
32 Perception about the scheme (renewing members) 39
33 Experiences of those who availed benefits (renewing members) 40
34 Experiences of those who availed the benefits before and after becoming 40
KRUPA members (renewing members)
35 Perception about the hospital (IP beneficiaries) 41
36 Perception about the scheme (IP beneficiaries) 41
37 Experience while taking services as KRUPA member (IP beneficiaries) 41
38 Experiences of those who visited the hospital both before and after 42
becoming members of KRUPA (IP beneficiaries)
39 Experiences of those who did not visit the hospital before becoming 42
members (IP beneficiaries)
40 Overall satisfaction over the decision of becoming a member (IP 42
beneficiaries)
41 Preference of health providing facilities (donor benefited) 43
42 Reasons for not preferring SK hospital (donor benefited) 44
43 Perception about the hospital (donor benefited) 44
44 Perception about the scheme (donor benefited) 45
45 Experience while availing benefits (donor benefited) 45
46 Experience of those who visited both before and after becoming members
45
(donor benefited)

List of figures:

No Title Page
1 Basic Designs of CHI 2
2 The design of the ACCORD-AMS-ASHWINI health insurance scheme 51

List of Abbreviations:

CHI: Community Health Insurance

SKAT: Shree Krishna Arogya trust

SKH: Shree Krishan hospital

KAS: KRUPA Arogya Suraksha

IP: In-Patient

OP: Out-Patient
MHC: Mini Health Centre

MPW: Multi-Purpose Worker

LFA: Lay First Aider