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Insuring primary care -- CARE Foundation

About the Project

Project Name: Insuring primary care -- CARE Foundation
Type of Facility Project: Microinsurance innovation grantee
Country of Operation: India
Region: Asia and the Pacific
Sub Topics: Business viability, Client interface, Impact, Value-added services, Health
Type of Risk Carrier: Other self-insurance scheme
Type of Distribution Channel: Healthcare centre

Organizational Overview

CARE Foundation is a non-profit organization with the mandate to make quality health care affordable and accessible to all through the appropriate use of technology. The Foundation implements its mission in three main ways: a) conducting research and providing specialized training, b) developing cost-effective medical products, and c) providing healthcare to low-income populations. To increase access to health in rural areas, the Foundation relies on local capacity building and technology solutions, implements solutions to create a more efficient supply chain, and has launched a microinsurance program. The Foundation works with innovative health care approaches such as tele-medicine, digital catheterization laboratory, and robotic surgery.


Project Description

The project aims to study the impact of microinsurance coupled with healthcare services delivered through hand held devices (HHDs). In rural areas, the population generally can only access poorly qualified medical professionals for primary care. Additionally, high illiteracy, and a general lack of awareness about good health practices and the importance of managing risks makes microinsurance very difficult to implement in rural India. Through voluntary health insurance, the project will enabl...READ MORE


The project targets agricultural workers whose average household income is below INR 2500 per month (US$ 55). It will also benefit low-income communities in rural areas such as nomadic tribes that have scarce access to healthcare facilities. The Foundation plans to provide health microinsurance in 50 villages that have approximately 100,000 residents.


Learning Agenda

The overall goal is to ascertain the efficacy and viability of outpatient financing and health care delivery in four key aspects: 

  • To what extent does technology enhance access and utilization of health care, facilitate claim processes, reduce costs and increase savings?
  • How does the model support the efficiency of the scheme in terms of claims management, cost reductions, healthcare expenditures, operating costs and renewal rates?
  • To what extent are VHCs effective in the prevention of diseases and promotion of healthy behaviour?
  • To what extent does the model contribute to health care delivery, and patient and provider satisfaction?

Project Status

Key Performance Indicators

Analysis Period – 1st November 2011 to 30th June 2012 (8 Months)

  1. Cumulative Policies sold:

2.       Number of Villages covered:


3.       Penetration:

a)      Enrolled Lives – 2049

b)      Enrolled Families – 487

c)       Range of Penetration 0.3% to 20%

d)      Average Penetration approx 4%

4.       Male/Female Enrolment:

51% : 49% respectively

5.       Enrolment across various Age Bands:

a)      0-18yrs – 853 Lives (42%)

b)      19-55 yrs – 1103 Lives (54%)

c)       > 55 Yrs – 93 Lives (4%)

6.       Occupation Break up (out of 487 Families):

a)      Daily Wages – 315 Families (65%)

b)      Farming – 139 Families (29%)

c)       Salaried Jobs – 18 Families (3%)

d)      Business – 12 Families (2%)

e)      Others – 3 Families (1%)

7.       Families WITH discount Vouchers:

426 Families  (87%)

8.       Families WITHOUT discount Vouchers:

61 Families (13%)

9.       Monthly Enrolment (Lives):

10.   Number of Claims:


a)      Female Cases– 675 (58%)

b)      Male Cases – 483 (42%)

11.   Incidence Rate:



12.   Age wise occurrence of Claims:


a)      0 – 18 Years – 397 Cases (34%)

b)      18 – 55 Years – 705 Cases (61%)

c)       > 55 Years – 56 Cases (5%)

13.   Amount Claimed:

Rs 42,494

14.   Average Cost per Claim:

Rs 37

15.   Disease Distribution (Top 3 systems involved), contributing 64% of the claims.

a)      Respiratory Disorders (URTI, LRTI, Allergic Bronchitis)– 300 Claims (26%)

b)      Muscular-Skeletal Disorders – 272 Claims (23%)

c)       GIT Disorders (Acidity, GE, Gingivitis) – 175 Claims (15%)

16.   Patients treated in the Village:

831 Patients (72%)

17.   Patients treated/Referred to the Clinic -  327 Pts (28%)

a)      100% of Urogenital & Typhoid cases were treated/referred to the clinic.

18.   Gross Premium Collected:

Rs 177,209

19.   Net Premium Collected:

Rs 73,348

20.   Claimed Amount:

Rs 42,494

a)      Claim Ratio on Gross Premium:24%

b)      Claim Ratio on Net Premium: 58%

21.   Gross Incurred Premium:

Rs 61,251

22.   Net Incurred Premium:

Rs 24,005

23.   Claimed Amount:

Rs 42,494

a)      Claim Ratio on Gross Incurred Premium - 69%

b)      Claim Ratio on Net Incurred Premium  - 177%

Note: Net Premium Collected  = (Premium – Subsidy for vouchers program + other discounts on product premium)

Project Updates
As of August 2009 (Project set-up) The project kicked off in June 2009. So far: CARE sought an insurance partner to bear financial risk for the outpatient product and to support product development, but none was found willing to underwrite a voluntary outpatient product. 34 VHCs were recruited to implement community surveys and sell health and hygiene sundries.  After gaining 6 months experience, VHCs will “graduate” to operate a HHD, which will enable them to do preventive c...READ MORE

Project Lessons

Note:  A 4-part video of CARE staff discussing lessons learned in the field as of July 2011 can be viewed in our YouTube channel. Click below to access the videos: Part 1: Key lessons on implementing hand held technology for use by health workers in a Primary Health Care microinsurance model Part 2: Tips on selecting a good technology when doing a microinsurance program at village level Part 3: Designing flexible premium payment system optio...READ MORE
On whether the information technology or intervention with hand held device is cost-beneficial for the sustainability of the scheme? If CARE had to implement the scheme again, they would use a mobile phone based solution that has a biometric card reader and thermal printer. The connectivity of this solution would likely be better and the cost would be about half ($300 versus $600 for HHD). CARE may roll out mobile solutions once the HHDs are at capacity...READ MORE
Does purchasing the insurance package increase the access to health care, health outcomes, and financial risk protection of the insured participants? Comprehensive field surveys are essential to provide data to develop more relevant product features and to understand attitudes, health seeking behavior and willingness to pay.  Due to little to no data on outpatient costs and utilization, CARE has had to make fairly broad assumptions based on focus groups...READ MORE
On what the likely impacts of public health interventions (preventive and promotive interventions) on health outcomes and expenditures in target population People with a history of self-employment and dynamism are better candidates to become successful entrepreneurs (VHCs).  Selecting and training the VHCs proved challenging.  Hiring proceeded in batches and before long it was apparent that at least one third of those hired were probably not able t...READ MORE
On project management It’s important to recognize the training needs of VHCs, clinical staff, and project staff and partners:  A dedicated implementation team training is invaluable to ensure commitment and focus on a very complex project multiple components.  CARE has had some staff turnover and observed gaps in skills as the project has unfolded, and then moved to try to address these.  One 2 day team building session was held in Jun...READ MORE
Date of last update:  April 2012