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Community Health Insurance: An Alternative for Extending Financial Protection to the Excluded Populations

Community Health Insurance (CHI) schemes provide an alternative to resource constrained low and middle income countries to increase financial resources available to the health sector as well as extend financial protection to excluded populations, comprising mostly the rural and informal sector and consisting of more than a billion of the world’s poor. CHI schemes have had modest success and require careful designing to meet the needs of the community and their high level of involvement to meet the health objectives of providing affordable and equitable access to all. There are unresolved issues with regard to sustainability, high administrative costs, ability to include the poorest, etc. However, it is a viable alternative which can supplement national efforts at universal financial protection. Drawing on the abundant literature on the subject, the paper examines the key characteristics of the CHI schemes and drawing on the successful interventions, suggests the requirements for scaling up CHI initiatives in the case of India and suggests some policy recommendations for incorporation in the national framework.