Equitable utilisation of Indian community based health insurance scheme among its rural membership: cluster randomised controlled trial.
OBJECTIVE
To evaluate alternative strategies for improving the uptake of benefits of a community based health insurance scheme by its poorest members.


METHODS
Prospective cluster randomised controlled trial.


METHODS
Self Employed Women's Association (SEWA) community based health insurance scheme in rural India. Participants 713 claimants at baseline (2003) and 1440 claimants two years later among scheme members in 16 rural sub-districts.


METHODS
After sales service with supportive supervision, prospective reimbursement, both packages, and neither package, randomised by sub-district.


METHODS
The primary outcome was socioeconomic status of claimants relative to members living in the same sub-district. Secondary outcomes were enrolment rates in SEWA Insurance, mean socioeconomic status of the insured population relative to the general rural population, and rate of claim submission.


RESULTS
Between 2003 and 2005, the mean socioeconomic status of SEWA Insurance members (relative to the rural population of Gujarat) increased significantly. Rates of claims also increased significantly, on average by 21.6 per 1000 members (P<0.001). However, differences between the intervention groups and the standard scheme were not significant. No systematic effect of time or interventions on the socioeconomic status of claimants relative to members in the same sub-district was found.


CONCLUSIONS
Neither intervention was sufficient to ensure that the poorer members in each sub-district were able to enjoy the greater share of the scheme benefits. Claim submission increased as a result of interventions that seem to have strengthened awareness of and trust in a community based health insurance scheme. Trial registration Clinical trials NCT00421629.
Ranson
M Kent
MK
Health Economics and Financing Programme, Health Policy Unit, London School of Hygiene and Tropical Medicine, London WC1E 7HT. kent.ranson@lshtm.ac.uk
Sinha
Tara
T
Chatterjee
Mirai
M
Gandhi
Fenil
F
Jayswal
Rupal
R
Patel
Falguni
F
Morris
Saul S
SS
Mills
Anne J
AJ
D016000:Cluster Analysis; D003153:Community Health Services / Q000706:statistics & numerical data*; D006291:Health Policy; D006801:Humans; D007194:India; D007348:Insurance, Health / Q000706:statistics & numerical data*; D017057:Medically Uninsured / Q000706:statistics & numerical data; D011446:Prospective Studies; D012423:Rural Health; D012959:Socioeconomic Factors