Extending health insurance to the poor: some experiences from SEWA scheme

This paper presents the health expenditure, morbidity pattern, demand for insurance and health seeking behaviour of low income households covered under ESIS, mediclaim and SEWA health insurance scheme. Survey reveals that share of direct medical costs was about two-thirds in the total costs in all groups and rural households invariably paid higher costs as compared to their urban counterparts. The per capita expenditure on treatment was much lower for ESIS households as compared to SEWA and non-insured households both in rural and urban areas. A majority of households indicated strong inclusions for any kind of health insurance scheme and demand for SEWA scheme was the highest among the non-insured. Both rural and urban households were willing to pay an annual per capita premium of Rs.80 and Rs.95 respectively for the coverage of services of hospitalisation, chronic ailment, specialist consultation and the like. The author strongly feels a need for health insurance among low-income households due to heavy burden of out-of-pocket expenses while seeking health care.