Chapter -1

INTRODUCTION

1.0 Introduction

1.1 Need for health care scheme

1.2 Taxonomy of health insurance

1.3 Motivation for the Study

1.4 Statement of the problem

1.5 Objectives

1.6 Hypotheses

1.7 Landscape of methodology

1.8 Scope of the Study

1.9 Limitations of the study

1.10 Organisation of thesis

Chapter One

INTRODUCTION

1.0 Introduction

The saying "health is wealth" is very much true in the present fast-paced life. If an

individual is not in the best of health, he will find it hard to do/enjoy anything else. An unhealthy

person cannot achieve much because of dealing with his sickness dominating his thoughts,

whereas an individual with a sound health will be motivated and will be able to achieve

anything. Ill-health not only gives a lot of suffering to the affected individual and his/her family,

but also leads to financial bankruptcy (D Rajasekhar et.al. 2011). The mean household

expenditure varies across the states, from the highest of ?9,196 (fNR) in Rajasthan to the lowest

of ?4,710 in Assam and in Kamataka is of ?6,686. Mean monthly consumption expenditure of

the non-poor households (HH) is ?8262 compared to ?2307 for the poor households. Nine

percent of non-poor households have become poor (impoverished) due to average Out-Of-Pocket

(OOP) expenditure of ? 1106 per month. Among both, poor and non-poor households, 21-24%

incurred catastrophic health care expenditure. OOP health payments constituted 13% of the

monthly consumption expenditure of the non-poor households in comparison to only 6% share

for the poor households (Sekher T.V et.al. 2012).

To accomplish mentioned direction, against the world average of four beds per 1,000

populations, India has 1.5 beds. To make this figure 2.5 beds, India requires ?5 lakhs crore by

2025 (R.Venugopal, 2009). Presently it has 6 lakhs doctors and 16 lakhs nurses, which cannot

fulfill the national needs. Hence our country needs another 15 lakhs doctors and 30 lakhs nurses

to come near the halfway mark at the global standards. In India, there is one doctor for every

10,000 population whereas it is 548 in the United State, 166 in the United Kingdom, 209 in

Canada and 249 in Australia on this extent our country need another 2 lakhs dental surgeons.

Beside this our country has around 60,000 doctors overseas (R.Venugopal, 2009). This is just to

give a glimpse of healthcare infrastructure in India.

The indicated commitment is needed in behalf of poverty and ill-health is intimately

related. The poor are often unable to have smooth consumption across periods of ill health and it

has been argued that 'catastrophic' health care expenses are a major entry point into poverty

across the world. In India, the mean household expenditure was ?6,671 (INR). The mean OOP

expenditure on health care was ?847. On an average, the OOP on health care was 13% of the

total household expenditure and 19% of the non-subsistence spending. Some researchers confirm

this: an extensive research programme undertaken across parts of India (Rajasthan, Gujarat and

Andhra Pradesh) and Africa (Ghana, Uganda and Kenya) found that ill health and health-related

expenses or health care finance were the most common reasons given by the poor for their own

descent into and inability to escape from poverty (Sekher T.V et.al. 2012).

To solve this problematic situation, intervention of government is essential in the form of

warranted health care for poor and farmers in India as well as in Kamataka. Because India is one

of the low-income country in the world with 26% population living below the poverty line, and

35% illiterate population with skewed health risks. But, it is an open question whether the

government should provide health care to directly empower the farmers' health status (e.g.

through vouchers) to obtain it from private providers or enter into Public-Private Partnerships

(PPP) with health providers and insurance companies. Designing and implementing large-scale

public service delivery systems is notoriously difficult, as the Indian experience illustrates: after

all, India is already supposed to have universal, free publicly provided health care. In practice the

better-off pay for private health services, leaving the poor to live and die with the corrupt, low-

quality and overburdened public hospitals. Researchers have shown that the poor spend

considerable amounts of money on health care, both in the private sector and the supposedly free

public sector. Private health care is not always high-quality, but unregulated providers tend to

offer low-quality care (Gobi .S et.al 2011).

1.1 Need for Health Care Scheme

As a result of this fact, there is an absolute need for health care scheme/insurance for the

rural poor fanners, so that they are able to overcome all the obstacles that might come their way.

With increasing awareness on health amongst farmers' and the newer generation, India is

gradually becoming health conscious. Owing to this realization, the health/medical

care/insurance sector is one of the fastest growing segments in India today. A lot of factors have

contributed to this change with the most important being the change in people's mindset about

'Health Insurance' (HI) (Kalaisigamani .J et.al. 2013). A suitable cover by the way of HI is all

that is required to cope with such situations. HI in a narrow sense would be 'an individual or

group purchasing health care coverage in advance by paying premium'. In its broader sense, "it

would be any arrangement that helps to defer, delay, reduce or ahogether avoid payment for

health care incurred by individuals and households".

The HI is attracting more and more attention of poor farmers in low and middle-income

countries as a means for improving their health care utilization and protecting households against

impoverishment from OOP expenditures. The health care financing mechanism was developed to

counteract the detrimental effects of user fees introduced in the 1980s, which now appear to

inhibit heath care utilization, particularly for marginalized populations and to sometimes lead to

catastrophic health expenditures. The World Health Organization (WHO) considers health

insurance a promising means for achieving universal health care coverage (Ernst Spaan et.al.

2012).

1.2 Taxonomy of Health Insurance

There are various types of HI available for the peoples including poor farmers in

Kamataka. National or Social Health Insurance (SHI) is based on individuals' mandatory

enrolment. Several low and middle-income countries, including the India, Philippines, Thailand

and Viet Nam are establishing SHI method. Voluntary insurance mechanisms include Private

Health Insurance (PHI), which is implemented on a large scale in developing countries like

India, Brazil, Chile, Namibia and South Africa, after-all Community Based Health Insurance

(CBHI), nowadays, this type of scheme or model is available in developing countries like India,

Democratic Republic of the Congo, Ghana, Rwanda and Senegal'. The various types of HI have

different impacts on the populations of the country as they serve. For example, PHI is said to

mainly serve the affluent segments of a population, but CBHI is often put forward as a health

financing mechanism that can especially benefit the poor farmers in Kamataka (Ernst Spaan

et.al. 2012; D Rajasekhar et.al. 2011). Countries wishing to introduce HI schemes into their

health systems should be aware of how their impact varies.

Instantly, the healthcare industry, with global revenue of over ?2.75 trillion is the largest

industry in the world. India has population of 1.21 billion as per in 2011 census experiences a

vast inequity that exists in the healthcare industry with barely 3% of the population covered by

some form of HI, either SHI or PHI. During the last 67 years, India has made considerable

'Sukumar Vellakkal (2007), "Health Insurance Schemes in India: An Economic Analysis of Demand Management under Risk Pooling and Adverse Selection", p 7-9

progress in improving its health status of its peoples. Death rate has been reduced from 40 to 9

per thousand, infant mortality rate has been reduced from 161 to 71 per thousand live births and

life expectancy has been increased from 31 to 63 years^. However, many challenges remain and

they are: life expectancy 4 years below world average, high incidence of communicable

diseases^, increasing incidence of non-communicable diseases, neglect of women's health,

considerable regional variation and threat from environment degradation. At any given point of

time 40 to 50 million of population are on medication for major sickness. About 200 million

days are lost annually.

The annual rate or range of out-patient: rural 30-152/1000, urban 9-81/1000 and for

hospitalization: rural 16-76/1000, urban 5-38/1000. As a result, in India, presently the HI exists

primarily in the form of Mediclaim policy offered to the individual or to any group, association

or corporate bodies. Although, total expenditure on health in India is nearly 6% of the entire

GDP, the government spending is less than 25% against the average spending of 30-40% in other

developing countries. Penetration of mediclaim is currently done by state-owned insurance

companies, covering only about 2.5 million people i.e less than 0.50% of the country's

population'*(P.K. Gupta, 2011).

1.3 Motivation for the Study

Out-of-pocket payments are the principal source of health care finance in most of the

states of India and the Kamataka is no exception. This evidence has important consequences for

household living standards. In most of the developing countries, including India, the poor

peoples' lion's share of health spending is made by OOP. This leads to impoverishment and low

^District wise health profile of TFR, IMR, CBR and CDR in Kamataka described in the chapter three. 'A detailed estimation of WTO on communicable diseases mentioned in chapter three. Coverage under VPHI in India 2009-10 to 2011 -12 is indicated in the subsequent chapter

access to health care facility, especially for weaker segments of the population. The only solution

for this is Micro Health Insurance (MHI) or CBHIs, like Yeshasvini Health Scheme (YHS) has

the potential to reduce the severe consequences of unforeseen illness of farmers.

However, in order to make use of the scarce resources available and build systems

offering value to the poor farmers, it is important to have a detailed and evidence based

understanding of the impact of Yeshasvini on the health and financial status of farmers.

In this way, Kamataka state has implemented this YHS for rural farmers; it is the first in

the developing world like India. YHS is attracting many researchers to investigate the aspects

important for the successful implementation of YHS as CBHI. It does so through a set of

controlled randomized trials through which YHS is implemented in all over Kamataka state,

India. And rigorous longitudinal research is used to identify causal effects of YHS on equitable

access to healthcare infrastructure and financial protection.

Providing HI or health care security for farmers continues to be one of the most important

unresolved policy issues for the world. Most of rural and informal sector workers in the world do

not have any form of HI. And in most developing countries, the rural and informal sectors

constitute the bulk of the population. In India, an estimate suggests that 90% of India's families

earn their livelihood from the unorganized sector, contributing 40% of the nation's GDP.

However, they are poor, most of them are not in employer-employee relationships, they do not

have any form of insurance or social security (e.g. maternity benefits, retirement, health

insurance, etc.,), nor do they have representative organizations that might help them fight for

these benefits.

To such a great extent, researches are essential to provide such benefits for the informal

rural farmers of Kamataka in particularly vulnerable to the lack of access to health care security.

Studies show that the poor spend a greater percentage of their budget on health related

expenditures (this varies between 6-8% in various studies). The burden of surgical treatment is

particularly devastating for major health issues and particularly when they seek "in-patient" care

or hospitalization. Further, the high incidence of morbidity cuts into their budget in two different

ways, i.e. they need to spend large amounts of money for surgical treatment and are unable to

earn money while under treatment. In fact, healthcare costs are one of the primary reasons for

rural indebtedness and poverty of farmers. It is estimated that at least 24% of all Indians

hospitalized fall below the poverty line because they are hospitalized and that OOP spending on

hospital care rises by 2% of the proportion.

Moreover, there is the issue of accessibility given that a majority of farmers' households

reside in remote rural areas, where there is no government or private medical facilities are

available. Obtaining treatment at a town or district level hospital involves travel costs, which are

not insignificant. Thus for many, simply accessing health care is by itself, an expensive

proposition.

However, a common perception is that the farmers are too poor to buy HI. While it might

be true for the poorest of the poor who struggle for survival every day, it need not be true for

those living close to the poverty line. Moreover, there is substantial evidence that if provided

with the opportunity, the farmer would be willing to pay for HI or health care schemes. A recent

study by Cumber and Kulkami (2000) suggest that the rural respondents in Gujarat were willing

to pay an annual premium of ?80 and ?95 for coverage of hospitalization, chronic ailment and

specialist consultation and an additional 16%, if there was coverage of transport costs, medicine

costs and diagnostic charges. However, a large number of the existing schemes for poor people

still involve part or full subsidies by the governments of various countries.

There are several obstacles stand in the way of providing HI to the rural farmers and

informal sectors' rural workers (Gerard La Forgia et.al. 2012; Ernst Spaan et.al. 2012). Thus, the

above factors motivate the systematic study of the impact of YHS in Kamataka. Due to such

importance this case study is focused on following areas; burden of diseases, health care

expenditure by OOP and by the government, taxonomy of HI and its development, key design

features of government sponsored HI schemes and Kamataka's health care sector, Yeshasvini

scheme, its design and coverage features, its potentials to contribute for universal coverage and

its role within Kamataka's health care finance and delivery system etc., are the area of subjects

of this research case study.

1.4 Statement of the Problem

The impact of HI in low and middle income countries has unfortunately been

documented only partially. Previous reviews have evaluated the performance of CBHIs in terms

of enrolment, financial management and sustainability. A recent review provides an overview of

the scope and origin of CBHI in low and middle income countries, with a particular focus on

India, China, Ghana, Mali, Rwanda and Senegal and also assesses CBHIs performance in terms

of population coverage, range of services included and reimbursement rate. HI is also known to

have effects on domains beyond those reported in existing reviews, such as social inclusion.

Furthermore, most reviews are available on the rapid development of HI in low and middle

income countries are somewhat outdated. No systematic reviews are available on the impact of

YHS. This limits to the direct comparison with other health care schemes operating in Kamataka.

In this way this research is carried out to make the systematic review regarding to the impact of

YHS on, enrolled members in YHS, YHS hospitalized and non-YHS cooperative members, in

terms of their health and financial status.

1.5 Objectives

1) To analyze the health insurance schemes of farmers in Kamataka.

2) To study the functioning of the prominent Yeshasvini health care scheme as a

community based health insurance in terms of technical and organizational

characteristics.

3) To assess the Yeshasvini health care scheme that is affordable, responsive and

inclusive which is designed to promote health care facilities of farmers in

Kamataka.

4) To examine the impact of Yeshasvini health care scheme in Shivamogga district

of Kamataka.

5) To identify emerging issues, opportunities, potential challenges and to

recommend policy measures for its expanding coverage and improving the

efficiency and effectiveness of Yeshasvini scheme.

1.6 Hypotheses

In order to achieve the above objectives, the following hypotheses are formed and tested

in the study.

1) Health Insurance lowers and/or avoids the cost of treatment at the point of

hospitalisation for rural farmers' in Kamataka.

2) The Yeshasvini health scheme is successively operating compared to SHI and

PHI with regard to farmers' health care schemes.

3) The YHS has influenced positively on the health status of mral farmers in

Kamataka.

4) YHS explicitly state that the health scheme was developed to prevent the rural

individual farmer from bearing the financial burden of hospitalisation.

5) One of the most active health care organization in Kamataka is Yeshasvini

Cooperative Farmers Health Care Trust, used as community health insurance as a

measure to increase solidarity among its members - "each for all and all for each".

1.7 Landscape of Methodology

For any scientific study the adoption of sound methodology occupies an important place.

The present study is an analytical research based on statistical methods applied to quantitative

and qualitative data. And it has concentrated on analyzing data in depth and examining

relationship from various angles by bringing in as many relevant variables as possible in the

analysis. In addition, diagnostic approach is applied wherever necessary.

This research work, being a case study, has adopted simple random sampling technique

to collect the primary data of samples. The primary study is restricted to the Shivamogga district.

On the basis of robust on the members of YHS via membership with co-operative societies in the

two taluks of Shivamogga district viz. Bhadravathi and Shikaripura were rationally selected on

the basis of geographical profile.

The main reason for this area selection is, its geographical situation, which means one's

(viz. Bhadravathi) agriculture depends more on irrigational facilities and less on rain. Viz.

another one (Shikaripura) is more on rain and less on irrigational facilities for their cultivation as

agriculture is the main source for their revenue. In the both taluk, the samples are selected

randomly on the basis of their membership of farmers with co-operative societies and the

hospitalisation in the scheme and enrollment with YHS. This selection is based on the study of

10

THE STUDY AREA

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A. Agarwal's observation. According to Agarwal (2009) 'the success of the any

community based health insurance is based on collection of the premium via their enrollment by

its members and remarkably considered this, the regular payment of the annual premium for their

health security, their financial status is very much important along with their educational status,

for their awareness on the health schemes'.

Thus, simple random sampling procedure is adopted to select the YHS

members/respondents in the category of; YHS Enrolled (YHS E) members (however not

hospitalized); YHS Hospitalized (YHS H) members and Non-YHS Co-operative Member

(NYCM) households (they remained as only member of co-operative society). Altogether, 180

samples from two taluks were selected randomly picking 90 sample farmers from each taluk, in

this 30 each from membership in co-operative societies, hospitalisation and non-YHS co­

operative members. The central part of the samples, are co-operative societies members only.

Along with this, during the time of selection, researcher has concentrated favorably of the

households belonging to those who are not economically stable to get hospitalisation facilities by

the private health care providers.

The fundamental and rational criteria for the random selection for the sample is the

minimum basic knowledge and mainly interested cooperative members on YHS and the chart 1.1

shows that the method of selection of sample and chart 1.2 shows the landscape of methodology

in the area of study.

12

Chart 1.1: Flow Diagram of the Selection of Samples in the Study Area

Bhadravathi

YHS Enrolled

30

'S

Shivamogga Dist. Total Samples 180

JL

Shikaripura

o

YHS Hospital isation

30

/ v

Non-YHS Co-Ope rative

Mem. 30

J V. y V.

YHS EnroUed

30

y V.

YHS Hospital isation

30

Non-YHS Co-Opera tive

Mem. 30

J \

This case study depends on both primary and secondary data for the analysis. The

secondary data are captured and collected from the reports, books, national and international

journals and articles, national and international conferences' edited volumes, brochures and

leaflets, and also the data taken from concerned health care schemes' reports and their volumes,

etc., unpublished and published sources by various government agencies; whereas the primary

data are collected by interviewing, FGDs with the farmer members of co-operative society and

staff and simple random sampling techniques as highlighted above. For the simple random

sampling purpose pre-tested questionnaire was prepared and used.

13

Chart 1.2: Landscape of Methodology

METHODOLOGY I

£ Review of YHS documents, records, registers, leaflets,

reports by consulting dept. of cooperative societies,

Shivamogga and Bangalore

1 Broad approach for

primary data collection

Selection of taluks and villages

a) Qualitative: FGD b) Quantitative: Households (HH)

survey schedule

I Data collection

T Cross checking and

validation

Analvsis

Key gaps and follow up of recommendation

14

Furthermore, to know the trends in the membership at the co-operative societies, 8

villages have been selected from the two taluks of the study area. First, in the each study area

randomly two hoblies have been selected. In the each hoblies four villages were chosen for the

selection for co-operative societies.

1.7.1 Definitions of sample groups:

• YHS E: are those who may not have enrolled in the previous YHS year, however,

according to survey period of 2011-12 they were enrolled or renewed in the YHS.

• Likewise, YHS H: thirty HH are taken from the 2011-12 Yeshasvini year hospitalized

household and also,

• NYCM are from the respected Yeshasvini year. They may have got enrolled in the

previous year, but in 2011-12 they have not renewed or enrolled in YHS, yet remained

only as members of cooperative societies.

1.7.2 Analytical Techniques

The information/data collected from both sources are analyzed with the help of

conventional tabular analysis, charts, graphs and suitable diagrams and have been used in

interpretation. Simple statistical tools like CAGR method, measures of central tendency,

percentages and averages has been used in the discussion and interpretation of the data gathered.

1.7.3 Calculating Percent (Straight-Line) Growth Rates

The percent change from one period to another is calculated from the following formula:

( 'Present— 'Past/

V r Past

PcR ^^"O N

Where:

PctR = Percent Rate

V Present = Present or Future Value

V Past - Past or Present Value

The annual percentage growth rate is simply the percent growth divided by A', the

number of years.

1.7.4 Compound Annual Growth Rate

CAGR is a useful measure of the growth of health care expenditure or investment over

multiple time periods by government or OOP, especially if the value of health care outlay has

fluctuated widely during the time period in question.

CAGR is in outlay of specific term for the geometric progression ratio that provides rate

of outlay over the time period. CAGR is not an accounting term, but it is often used to describe

some element of the HI sector.

1

(tn-to)

CAGR (to,tn) = ( V ( t n ) / V (to)) - 1

Where:

• V(to): (to): the start of expenditure, (or initial value)

• V(t„): the last year of expenditure observed

16

• to - the first year of observations.

• tn - the last year of observations.

Actual or normalized values are used for calculation as long as they retain the

same mathematical proportion.

1.7.4.1 Verification:

The formula to check CAGR is:

(tn-to) V(t„) = V(to)X(l+CAGR)

1.8 Scope of the Study

The present study aims at analyzing the impact of YHS on farmers and peasants of

cooperative society. The study deals with the contribution of farmer members of co-operative

society to YHS financial status and OOP expenditure. In view of the difficulties involved in

covering the entire state a unit has been selected. In order to study the objectives and achieve

greater accuracy, Shivamogga district of Kamataka has been purposefully selected as unit of

study. In a nutshell, the study aims at evaluating the impact of YHS on farmers through

cooperative society in Shivamogga district. This study mainly relates to health scheme of the

farmers in Kamataka, specifically Yeshasvini health care scheme of Kamataka and also the

health care expenditure of Gol as well as GoK and diseases pattem in the states and country. It

analyses the level of awareness, progress, achievements and impact of the YHS in Shivamogga

district.

17

1.9 Limitations of the Study

At this juncture, it is essential to mention the limitations to which a study like this is

subjected to. As stated earlier in the scope of the study, the study pertains only to analyse the

broader areas of impact of YHS on selected sample farmers of co-operative societies in

Shivamogga district for a specific period (2011-12) and hence excludes a deeper enquiry into the

other aspects of CBHI. The study does not cover any districts other than Shivamogga district for

primary data. Further, this present case study is beset with certain limitations, they are

enumerated here:

1. At various stages, the basic objective of the study suffered due to inadequacy of

time series data from related cooperative departments and co-operative societies.

There has also been a problem of sufficient homogenous data from different

sources (Like ILO, NABARD, researchers, WHO, PHFI, MoHFW, many

government departments including planning department of state and planning

commission of country, etc,.). For example, the time series used for different

variables, the averages are used at certain occasions. Therefore, the trends, growth

rates and estimated regression coefficients may deviate from the true ones.

2. The field study is covered only to Yeshasvini health care scheme, along with

other schemes which are supporting to farmers' health care status and this does

not cover the private and public insurance companies for deeper study of health

care products and users.

3. Researcher faced by some major constraints of various resources like time and

money. So the researcher forced himself to select a cluster of only two taluks for

18

the case study. Hence, results are largely applicable to those areas where similar

conditions prevail, with the problem of various resources like time.

4. The interview method of data collection requires the respondents to recall from

their memories about their hospitalization. Hence, the findings may be subjected

to memory lapses of the respondents.

5. Hardly, very few studies have been carried out and published on the Yeshasvini

health care scheme of Kamataka. Hence, the study has been done on the basis of

data collected from primary source and availed secondary sources also.

1.10 Organisation of Thesis

This study has been presented in six chapters as indicated below:

Chapter I: Introduction

Chapter I, deals with theme, nature, motivation for the study, statement of the problem

and importance of the present study. The objectives of the study, hypotheses to be tested are also

specified. The scope and limitations of the study are presented at the end.

Chapter II: Concepts and Review of Literature

Chapter II, describes comprehensively a review of the relevant research work done in the

past related to the present study.

Chapter III: Health Insurance Sector in Karnataka - A Critical Analysis

Chapter III, presented in two parts namely, Health Insurance Sector - A Glimpse and

Health Insurance Sector in Kamataka. Comprehensively, this chapter provided the critical

analytical look inside of health care and insurance sector in Kamataka, which is captured and

19

collected by secondary data. The major analysis relates to the genesis and growth process of

health care expenditure by the government and private OOP of people, taxonomy, development

of HI, key design features of government sponsored HI schemes and Kamataka's health care and

health insurance sector along with India and world.

Chapter IV: Benchmark Information of Yeshasvini Health Scheme in Karnataka

Chapter IV, presented in two parts:

Part-I: Devoted for a brief picture relates to socio-economic status of farmers in the study

area of Shivamogga district of Karnataka state, India, as they supported information for the

present study through a brief picture of cooperative society movement and its status in state and

Shivamogga district.

Part-II: Presented the information about the theoretical background of the YHS and also

this chapter analyzed the YHS in Karnataka, with special concentration on the study area on the

basis of data captured by secondary source.

Chapter V: Analysis and Interpretation of Results

Chapter V, discusses the results of the study and it devoted for the results on ethnics of

respondents and their health status, chronicle illness and deceases and other related to the OOP

expenditure of the farmers in Shivamogga district of Karnataka.

Chapter VI: Key Gaps, Recommendations and Conclusion

Chapter VI, provides summary of the whole study and also suggest the recommendations

based on the findings of the study. At the end, bibliographies have been listed related to the

present study.

20

REFERENCES

Aggarwal A. (2010), "Impact evaluation of India's 'Yeshasvini' community based health

insurance programme", Health Economics 19 (Suppl.), pp 5-35.

Alton V, Eckerlund I and Norlund A. (2006), "Health economic evaluations: how to find

them", International Journal of Technology Assessment in Health Care 22: pp 512-517.

Basaza R, Criel B and Van Der Stuyft P. (2008), "Community health insurance in Uganda:

Why does enrolment remain low? A view from beneath", Health Policy 87, pp 172-184.

Bennett .S, Creese A and Monasch, R. (1998), "Health Insurance Schemes for People Outside

Formal Sector Employment", Geneva, WHO, pp 18-72.

D. Rajasekhar, Erlend Berg, Maitreesh Ghatak, R. Manjula and Sanchari Roy (2011),

"Implementing Health Insurance: The Rollout of Rashtriya Swasthya Bima Yojana in

Kamataka", Vol. XLVI No 20, Economic «& Political Weekly, May-14, pp 56-59, 61-63.

Dave, P. (1991), "Community and Self-financing in Voluntary Health Programmes in India",

Health Policy and Planning, Vol. 6, No.l, pp 20-31.

Devadasan, N., Manoharan, S., Menon, N., Menon, S., Thekaekara, M., Thekaekara, S. and

AMS Team. (2004), "ACCORD Community Health Insurance: Increasing Access to

Hospital Care", Economic and Political Weekly, July 10, 2004. pp 02-14

Ellis, R, Alam, M, and Gupta, I. (2000), "Health Insurance in India: Prognosis and

Prospectus", Economic and Political Weekly, 35 (4), pp 207-217.

Gumber and Anil. (1997), "Burden of Disease and the Cost of Ill-health in India: Priorities for

Health Interventions During the 9th Plan", Vol. 29, No.2, pp 133-172.

Gumber and Anil. (2002), "Health Insurance for the Informal Sector: Problems and Prospects",

Working Paper No.90, Indian Council for Research on International Economic Relations,

pp3-15.

Gumber Anil and Kulkarni, V. (2000), "Health Insurance for Informal Sector: Case Study of

Gujerat", Economic and Political Weekly, Septemvber 30,2000, pp 6-18.

Gumber, Anil and Kulkarni, V. (2000a) Health insurance for workers in the inforlmal sector:

Detailed results from a pilot study. National Council of Applied Econopmic Research.,

pp 2-12.

Kannan, K.P. (2002), "Social Dialogue Process in the Informal Sector: The Kerala Experience

of Welfare Funds", ILO, New Delhi, pp 22-36.

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McCord, M, Isem, J., and Hashemi, S. (2001), "Microinsurance: A Case Study of An Example

of the Full Service Model of Microinsurance Provision", MI Center, Microsave. pp 1-9.

Pooja Kansra and Gaurav Pathania (2012), "A Study of Factor Affecting the Demand for

Health Insurance in Punjab", Journal of Management and Science, Vol. 2. No.4. Dec

2012, pp 5-18, 23-49, 35-94.

Sekher. T.V. and Kaushalendra Kumar (2012), "Catastrophic Health Expenditure and Poor in

India: New Evidence from a Nation-wide Survey", International Institute for Population

Sciences (UPS), Annual Meeting Programme, pp 1-10.

Shariff A., Cumber A., Duggal R., and Alam M. (1999), "Helath Care Financing and

Insurance Perspective for the 9th Plan 1997-2002", Margin Vol.31, No.2, Jan-March, pp

20-58.

Van Ginneken W. (1999), "Social Security for the Excluded Majority. Case Studies of

Developing Countries", Intematonal Labour Office (ILO), Geneva, pp 12-38.

Venugopal .R (2009), "Health Insurance in India", National Insurance Academy, Pune, ICFAI,

University Press, February, pp 55-61.

Gobi .S and R. Parthasarathy (2011), "Selected Health Insurance Schemes in India", AJRSH,

Vol.1, Issue 4, pp I-10.

Kalaisigamani .J and A. Sangameshwaran (2013), "Health Insurance in India", Health and

Medical Care Services: Claims on National Resources, Vol.13:4 April, pp 1-11.

Ernst Spaan, Judith Mathijssen, Noor Tromp, Florence McBain, Arthur ten Have and Rob

Baltussen (2012), "The impact of health insurance in Africa and Asia: A systematic

review", Bulletin of the World Health Organization-2012;90:685-692, pp 1-14, 17-20.

Gupta P.K. (2011), "Insurance and Risk Management", Himalaya Publishing House, Second

Edition, pp 530-546.

La Forgia, Gerard and Somil Nagpal (2012), "Government-Sponsored Health Insurance in

India: Are You Covered?", Directions in Development. Washington, DC: World Bank.

doi:l0.1596/978-0-8213-9618-6, Creative Commons Attribution CC BY 3.0, pp 5-29, 96-

169,230-361,380-432.

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