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Bringing "health" into health insurance -- Vimo SEWA

About the Project

 
Project Name: Bringing "health" into health insurance -- Vimo SEWA
Type of Facility Project: Microinsurance innovation grantee
Country of Operation: India
Region: Asia and the Pacific
Sub Topics: Business viability, Business models, Impact, Improving value, Health
Type of Risk Carrier: Other self-insurance scheme
Type of Distribution Channel: Bank
 

Organizational Overview

The Self Employed Women’s Association (SEWA) is an Indian trade union registered in 1972 which today has over 1.3 million members in nine states of India.  SEWA members are poor women workers in the informal economy, including agricultural labourers, service providers, home-based workers, and vendors.  Since 1992, SEWA has offered a composite insurance product (life, hospitalization, accident, and asset insurance) known as VimoSEWA (meaning SEWA insurance) for members and their families in India.

VimoSEWA’s experience confirms a high demand by clients for protection against the costs of prevention and treatment of illness.  Over 90 per cent of VimoSEWA’s claims are for illness.  More specifically, the data indicate that at least one third of these claims result from preventable acute illnesses such as malaria, gastroenteritis, and water-borne diseases that, if treated early on, should not require hospitalization.  Unnecessary hospitalization results in loss of income and assets for the poor and negatively affects health.  Furthermore, fewer hospitalizations can improve the viability of insurance by reducing claims expenses.

 

Project Description

VimoSEWA believes that preventive health information, access to immediate treatment, and outpatient health care services can reduce the number of patients hospitalized for common illnesses, resulting in savings for families who otherwise incur avoidable out of pocket expenses, as well as for the insurance programme.  The project aims to test if implementing targeted community health education and referral for common illnesses has an effect on insurance claims, health-related expenditure, an...READ MORE
 

Beneficiaries

This research initiative will target workers in the informal economy in urban and rural Gujarat, India. SEWA members are home-based workers, producers, vendors, and manual laborers including agricultural laborers. They do not have basic statutory social protection such as health care benefits, maternity or sick leave, pension and access to child care.

 

Learning Agenda

As very little evidence exists in this area, VimoSEWA aims to create both an implementation model and evidence base for integration of health activities with health insurance. This project will address five key questions through action research using a controlled study of the impact of health interventions amongst insured households.

  • How does a community health program impact health seeking behavior?
  • Does a community health program reduce health insurance claims and/or out of pocket illness expenditure for preventable, primary illnesses?
  • What health education messages are effective in reducing unnecessary hospitalization?
  • What is the pattern of treatment sought for the most common illnesses?
  • Does a community health program contribute to the viability of health insurance?

Project Status

Key Performance Indicators

The following are 2010-2012 figures for the health benefits under VimoSEWA’s composite insurance product:

Indicator

2010

2011

2012

Polices

   

 

Overall VimoSEWA

101,397

99,117

79,824

Ahmedabad City

27,627

44,510

45,999

Ahmedabad District

7,097

9,632

9,543

Claims ratio

   

 

Overall VimoSEWA

103%

105%

161%

Ahmedabad City

94%

140%

172%

Ahmedabad District

120%

99%

136%

Renewal ratio

   

 

Overall VimoSEWA

65.8%

64%

59%

Ahmedabad City

79.64%

82%

73%

Ahmedabad District

61.06%

59%

57%

Rejection ratio

   

 

Overall VimoSEWA

13.33%

16%

13%

Ahmedabad City

15.53%

17%

13%

Ahmedabad District

15.52%

13%

10%

 
 
 
Project Updates
As of February 2010 Research Design The project was designed as a cluster randomised trial.  Treatment and control clusters were chosen among the population using statistically robust techniques, creating a sample of 1,960 households (in 28 clusters) to test the effect of the interventions on both insured and uninsured households.   Sampling the uninsured populated presented a number of challenges. During the project design phase, VimoSEWA expected to use government census dat...READ MORE

Project Lessons

On partnerships for action research* Close collaboration is needed between the researchers, the implementing organization, and an academic advisor who understands the local context and the realities of the intervention is essential. The academic advisor brings rigour and objectivity, while the project team has access to and credibility among the community.  Intense collaboration is necessary to: i) maintain methodological rigour, such as avoiding contam...READ MORE
 
 
On designing action research on preventative health care interventions It is essential to analyse the frequency and cost of health claims on a consistent and comparable basis to uncover what is really driving trends.  For example, instead of focussing on the total number of claims incurred and their aggregate cost, VimoSEWA segmented and analysed several years of claims data on a standard and thus comparable basis (e.g. number of hospitalizations per 1,...READ MORE
 
 
On carrying out action research on health interventions Careful testing and piloting should be used to adapt methods to local realities. Surveys, in particular, should be tested thoroughly before household interviews begin. Based on the experience of VimoSEWA, it is critical to test a range of methods to define and measure illness, particularly for minor illnesses.  Local individuals who are familiar with the culture and available services should b...READ MORE
 
 
On the findings of the action research Morbidity patterns are a key, yet often overlooked, indicator of the performance of a microinsurance scheme and the health care delivery system. The illnesses that drive claims shed light on why claims are incurred.  Morbidity patterns also inform insurers about the effectiveness of health care delivery, and how clients access care for various illnesses.  This information can suggest ways to intervene to impro...READ MORE
 
 
Project page contributor/s:  Sapna Desai (VimoSEWA) and Jeanna Holtz (the Facility)
 
 
Date of last update:  April 2013