MR Microinsurance_2012_03_29.indd - International Labour ...

70 Emerging issues
Box 3.2 Impact of “Yeshasvini” Health Insurance Programme in India
Aggarwal (2010) evaluated the Yeshasvini scheme that provides voluntary
health microinsurance microinsurance to members of rural cooperative societies and their
families families in India’s India’s Karnataka state. Its Its benefi ts include include surgery, free outpatient
consultations and discounted laboratory tests when ill. At the time of Aggarwal’s
research, its 2.7 million members paid annual premiums of US$2.40 for cash-
less coverage of up to US$4 000 available in a network of 349 specially-selected
hospitals. Th e plan is administered by a tripartite alliance of public, private and
cooperative sector organizations and subsidized by the state government and
private contributors.
Th e main evaluation question was: How does the Yeshasvini scheme impact
out-of-pocket expenditures, fund mobilization, income and consumption
smoothing, healthcare utilization rates and treatment outcomes? Aggarwal used
a quasi-experimental technique called propensity score matching, whereby
uninsured comparison households are individually matched to participating
households based on their probability of enrolling given the presence of partic-
ular observable characteristics (like earnings and years of education). Th is
approach reduces bias by creating more comparable treatment and control
groups, but does not account for the eff ects of self-selection based on unobserv-
able factors (like risk-aversion or engagement in unsafe activities). Th e study
used a sample of 4 109 randomly-selected households covering 21 630 people in
82 villages in rural Karnataka state.
In the event of surgery involving catastrophic expenditures, Yeshasvini sub- sub-
scribers borrowed 30 to 36 per cent less than uninsured patients and spent up to
74 per cent less from sources including personal incomes and savings. Besides a
higher incidence of surgery, member households reported 6 to 7 per cent more
medical consultations concurrent with a 19 per cent reduction in the share of
visits made to public facilities. While treatment outcomes varied according to
members’ socio-economic status, no appreciable impact on maternal health
care was detected (possibly because the scheme did not historically cover
deliveries). Perhaps most interestingly, average annual income growth (over the
prior three years) was determined to be signifi cantly higher among policyholding
households.
Source: Adapted from Aggarwal, 2010.