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Palgrave Macmillan, Geneva Papers on Risk and Insurance - Issues and Practice, 2(39), p. 280-303

DOI: 10.1057/gpp.2013.31

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Implementing a Participatory Model of Micro Health Insurance among Rural Poor, With Evidence from Nepal

Journal article published in 2014 by David M. Dror ORCID, Atanu Majumdar, Pradeep Panda, Denny John, Ruth Koren
This paper is made freely available by the publisher.
This paper is made freely available by the publisher.

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Abstract

This paper reports on two voluntary, contributory, contextualized, community-based health insurance (CBHI) schemes, launched in Dhading and Banke (Nepal) in 2011. The implementation followed a four stage process: initiating (baseline survey), involving (awareness generation and engaging community in benefit-package-design), launch (enrollment and training of selected community members) and post launch (viable claims ratio; settled within satisfactory time, sustainable affiliation). Both schemes were successful on four key parameters: effective planning; affiliation (grew from 0 to about 10,000) and renewals (>65%); claims ratio (~50%); and promptness of claim settlement (~23 days). This model succeeded in implementing CBHI with zero premium subsidies or subsidized healthcare costs. The successful operation relied in large part on the fact that members trust that they can enforce this contract. Considerable insurance education and capacity development is necessary prior to launch of the CBHI, and for sustainable operations as well as for scaling.