Ot 25024 - 48 Report

INTRODUCTION TO COMMUNITY HEALTH INSURANCE
According to the World Health Organization, greater than 80 per cent of total expenditure
on health in India is private and most of this flows directly from households to the
private-for-profit health care sector. Most studies of health care spending have found that
out-of-pocket spending in India is actually progressive, or equity neutral; as a proportion
of nonfood expenditure, richer Indians spend marginally more than poorer Indians on
health care. However, because the poor lack the resources to pay for health care, they are
far more likely to avoid going for care, or to become indebted or impoverished trying to
pay for it. On average, the poorest quintile of Indians is 2.6 times more likely than the
richest to forgo medical treatment when ill. Aside from cases where people believed that
their illness was not serious, the main reason for not seeking care was cost. The richest
quintile of the population is six times more likely than the poorest quintile to have been
hospitalized in either the public or private sector. Peters et al (2002) estimated that at least
24 per cent of all Indians hospitalized fall below the poverty line because they are
hospitalized, and that out-of-pocket spending on hospital care might have raised by 2 per
cent the proportion of the population in poverty. Given this context, health insurance
appears to be an equitable alternative to out of pocket payments.
In recent years, community health insurance (CHI) has emerged as a possible means of:
(1) improving access to health care among the poor; and (2) protecting the poor from
indebtedness and impoverishment resulting from medical expenditures. It represents an
effective way to protect people from the costs of health care.
Community Health Insurance can be defined as: “any not-for-profit insurance scheme
that is aimed primarily at the informal sector and formed on the basis of a collective
pooling of health risks, and in which the members participate in its management.”
CHI schemes involve prepayment and the pooling of resources to cover the costs of
health-related events. They are generally targeted at low-income populations, and the
nature of the ‘communities’ around which they have evolved is quite diverse: from people
living in the same town or district, to members of a work cooperative or micro-finance
group. Often, the schemes are initiated by a hospital, and targeted at residents of the
surrounding area. As opposed to social health insurance, membership is almost always
voluntary rather than mandatory.
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Underlying Objectives
Most of the insurance programs have been started as a reaction to the high health care
costs and the failure of the government machinery to provide good quality care. The
objectives range from “providing low cost health care” to “protecting the households
from high hospitalization costs.” BAIF, DHAN, Navsarjan Trust and RAHA explicitly
state that the health insurance scheme was developed to prevent the individual member
from bearing the financial burden of hospitalization. Health insurance was also seen by
some organizations as a method of encouraging participation by the community in their
own health care. And finally, especially the more activist organizations (ACCORD,
RAHA) used community health insurance as a measure to increase solidarity among its
members – “one for all and all for one.”
The basic designs:
INSURANCE
PROVIDER+INS COMPANY
URER R
IU EM
INSURER E
PR
M
I
P C F M PROVIDE
R ees NGO
A P PROVIDER B R
E R R U
M C P
E E R
I A R
M S
U R E
I E
M E M
U
I
COMMUNITY COMMUNITY U COMMUNITY
PROVIDER MODEL INSURER MODEL LINKED MODEL

Fig 1: Basic designs of CHI
In India, there appear to be three basic designs, depending on who is the insurer (see the
Figure). In Type I (or HMO design), the hospital plays the dual role of providing health
care and running the insurance program. In Type II (or Insurer design), the voluntary
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organization is the insurer, while purchasing care from independent providers. Finally in
Type III (or Intermediate design), the voluntary organization plays the role of an agent,
purchasing care from providers and insurance from insurance companies.
At most of the schemes, the unit of enrolment is the individual and membership is
voluntary. While some of the CHI schemes limited the benefit package to only
ambulatory care, most provided inpatient care. Some also provide outpatient care as well
as outreach services. It is observed that the community prefers to have both outpatient
and inpatient care. Most schemes had important exclusions like pre-existing illnesses,
self-inflicted injuries, chronic ailments, TB, HIV, etc. While most of the schemes
reimbursed direct costs of treatment (consultation, medicines and diagnostics), one
scheme (Karuna Trust) also reimbursed loss of wages for the patient. Some CHIs had also
added other benefits like life insurance, insurance against personal accident and/or asset
insurance into the package to make it more attractive to the community.
In the Type I CHIs, there is a cashless system of reimbursement. However, in the other
two types, usually it is a fixed indemnity with patients having to settle bills and then
getting it reimbursed 2-6 months later from the NGO. The exception was the Yeshasvini
scheme, which, though a Type III scheme, had managed to negotiate a cashless system
with the private sector by using the services of a Third Party Administrator (TPA). Most
of the CHIs have a fixed upper limit of coverage.
One of the general weaknesses of the CHIs is the lack of techno-managerial expertise.
This is reflected in the fact that most of them do not have inbuilt mechanisms to prevent
adverse selection or moral hazard. Due to the asymmetry of information, it is possible
that only the sick enroll in these schemes (adverse selection). Because of the insurance
programme, the behavior of the patient or the provider may change (moral hazard). The
only measure consistently used by most CHIs to reduce the patient induced moral hazard
is co-payments and deductibles. The most common reasons found for not enrolling are:
(1) No immediate benefit; (2) premium too high; (3) “we are well, why we should pay in
advance? When we fall sick, we shall pay”; (4) large families – this is specially since
most of the CBHI’s unit of membership is the individual; (5) “(Insurance scheme)
Hospitals are far away and so we have to pay a lot to access hospitalization. Better use
the premium money to go to a nearby doctor”; and (6) “we pay every year, but do not get
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any benefit out of it. So we have decided not to pay anymore”. There is tremendous
variation in terms of claims submitted annually for inpatient care, ranging from only
1.4/1,000 insured per annum to more than 240/1,000 insured per annum. Among schemes
with the highest rates of utilization, adverse selection may be responsible for the high
rates.
Those schemes that provide the greatest degree of protection have the following
characteristics: (1) Cover 100 per cent of the direct costs; (2) cover all (or at least some)
of the indirect costs; (3) cover all kinds of illness (for example, all non elective causes of
hospitalization, including complications of delivery, chronic illnesses); and (4) provide
benefit right at the source of health care, i.e., with no period during which the patient has
to cope with the costs of care.
It was generally the Type I schemes, which provide health care directly, and usually with
no upper limit to the financial benefits, which provided the greatest degree of protection.
An important question is about the financial viability of these ‘small’ schemes. Some are
run purely on funds raised from the community. All the Type I schemes have
supplemented the locally raised resources with external resources (either from the
government or donors).
It is clear that what is required is a good product. Some of the conditions that have
allowed these schemes to succeed are:
– An effective and credible community based organization (or NGO). This is absolutely
necessary as it is the foundation on which health insurance can be built. The CBO helps
in disseminating information about health insurance and more importantly helps in
implementing the program with minimum costs.
– An affordable premium – this is very important. This is significant, and needs to be
taken into account by the insurers if they want their products to penetrate the rural
market.
– A comprehensive benefit package is necessary to convince the community of the
benefits of health insurance. While most insurance companies introduce exclusions,
based on economic reasons, one has to look at health insurance within a public health
context. Diseases like TB, HIV and mental illnesses have significant public health
importance and should be covered. Similarly it is ironic that while the country has
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invested tremendously in safe deliveries, most health insurance products do not cover it.
And finally as India enters an epidemiological transition and will have to encounter
chronic diseases like diabetes and hypertension, it becomes imperative that these diseases
are included in the benefit package.
– A credible insurer is imperative for people to have faith in the product. This is where
the NGOs and the CBOs score as they have a relationship with the community and so the
people are willing to trust them with their money.
– And last but not the least, the administration load of the scheme on the community
should be minimal. Unnecessary documentation leads to frustration.
Given the new Insurance act (IRDA Act 1999), another issue is the legality of these
schemes. Currently the act does not acknowledge the presence of these schemes and their
role in the larger insurance market. This could also be the reason why many of the newer
schemes have linked up with the formal insurance companies – to legitimize their
activity. But in the process, they may have lost on the flexibility and innovations
necessary for a successful CHI. The other issue that needs to be addressed is that of
financial sustainability. The very fact that many of them have been operational for more
than a decade itself is a proof that it may be a sustainable form of health financing. While
accurate financial data about the schemes were not available easily, rough estimates show
that they are able to raise about 60 to 100 per cent of their resources. This has important
policy implications, as it gives an indication towards the amount subsidy required to
make these schemes viable. And given the fact that most of these schemes target the poor,
it could help if the government comes forward to subsidize this equitable health financing
mechanism.
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INTRODUCTION TO THE SCHEME:
Provider and insurer - Shree Krishna Arogya Trust (SKAT):
SKAT is a not for profit organisation working under the aegis of Shree Krishna Hospital.
The primary objective of SKAT is to plan & implement programmes for easing the access
to modern medical services of this institution to all those desiring these but often failing
to afford.
Shree Krishna Hospital (SKH), managed by Charutar Arogya Mandal, is a 550-bed
hospital with state of the art facilities like Trauma centers, ICUs and Laboratories. The
hospital is operational since 1981. Based on its capacities, SKH desires to extend its
services to poor & marginalized rural communities in a manner that modern medicines
and medical facilities are easily accessed by rural masses in the district. The first
initiative for SKAT has been designed as a Health Security programme called “Krupa
Arogya Suraksha (KAS)”. SKAT is based in the premises of SKH at Karamsad. The other
location for extension of KAS subscription services is at Mayank Jayant Foundation,
Anand, extension centres at Petlad and Ardi.
Legal form of SKAT:

SKAT is primarily designed to extend contributory subscription based In Patient facility
of modern hospitals to society at large. In technical terms it may be considered a micro-
finance service package to a community. There have been instances in recent past that
such institutions have been designed with a combination of a not for profit legal form
along with a profit making body. The not for profit form is to seek the best assistance
available from benevolent organizations (state, private, others) and support of a profit
making body is to manage a team professionally on a target driven modus operandi.
Objectives of the trust:

The principal objective of the Trust is to carry on charitable activities of
enabling/channeling easy access to the modern health care, medical treatment and relief
and education to the needy poor and marginalized sections of society without any
distinction of caste, creed, religion or community.
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Network of Hospitals:
At present, arrangements have been made for treatment of members participating in KAS
at Shree Krishna Hospital, Karamsad. Arrangements have also been made for accessing
facilities for Cardiology (Heart related) being provided at Escorts-Bhailal Amin Heart
Research & Care Centre through an institutional arrangement with Bhailal Amin General
Hospital, Baroda and for Urology (Kidney related) at Muljibhai Patel Urological
Hospital, Nadiad. Patients requiring coronary or urological services are however required
to first get themselves admitted at Shree Krishna Hospital and based on the advice of the
specialists at the hospital only these services are made available to the persons.
Krupa Arogya Suraksha (KAS):

The product:
KAS is designed as a health insurance product with special emphasis on meeting the
expectations of the community in rural and urban areas, keeping in mind the rural poor:
as the current hospitalization expenses (even if they are charged at a subsidized rate) are
unaffordable for them. KAS offers its services for insurance covers of lower
denominations at premia lower than those offered by other insurance companies. KAS
envisages eliminating the procedural hassles related to reimbursements by the SKH
becoming the service provider of insurance. The name was chosen in a dialect understood
by masses meaning “Blessings for a health security”. The substance in the name is to
assure a member community that good health is a reality and together we may access
services required for it. The slogan means “May you live long” as any Indian elder would
bless some one younger to him meeting for the first time in a day. It has imbibed the
basic value that KAS intends to bring to the health of all.
Preamble:
Krupa Arogya Suraksha (KAS) is a social security programme aimed at extending the
safety net of good modern health facilities & services available at Shree Krishna Hospital
and other associated institutions to communities living in the villages and towns of the
districts of Kheda & Anand.
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The programme envisages an affordable annual subscription or one lifetime subscription
by a family participating in KAS for a certain limited free treatment of any illness
requiring Indoor Patient admission for which Shree Krishna Hospital or any other
hospital nominated by Shree Krishna hospital for the purpose has the facilities and
services. The programme does not cover free treatment or other services for outdoor
patients. There is a provision of a discount for the outdoor patients.
Eligibility to become member:

Any person between the age 91 days and 70 years of age residing in any village or town
of the districts of Kheda & Anand may subscribe and participate in KAS.
Subscription:
The following reckoner shows the extent of billed expenses at SKH, which may be
accessed as free services by paying a corresponding annual subscription by a person. All
the diseases/ailments of a general order requiring indoor patient admission at a designated
hospital would be treated up to a maximum limit of billed expenses based on a
corresponding annual subscription for KAS. The following amounts are to be paid and
the extents of free medical treatment are given in the table below:
Indoor Patient 46 yrs to 6061 yrs to 70

treatment expenses 19 yrs to 45 yrsyrs Personyrs Person
up to the following3 months to 18 yrsPerson / Year/ Year/ Year
yearly limits (Rs) Child / Year (Rs) (Rs) (Rs) (Rs)
5000 80 90 135 500
10000 155 178 265 975
15000 225 265 390 1450
20000 300 350 520 1900
25000 370 435 640 2350
50000 725 825 1225 4500
100000 1400 1600 2400 8500
Table 1: Yearly subscription fee and corresponding indoor patient expense coverage
One time subscription for seeking services of KAS:
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Any person above 18 years and below 45 years of age may contribute a one-time
subscription as per the table given below, which will enable him/her to avail
corresponding IP services for 25 corresponding years or up to 60 years of age (whichever
is less):
Sl. Indoor patient treatment expenses up to the One time subscription

following limits @Rs./person @Rs./person
1 5000 1500
2 10,000 2900
3 15,000 4300
4 20,000 5700
5 25,000 7100
6 50,000 13400
7 1,00,000 25000
Table 2: One-time subscription rates
Subscription for KAS in food grain contributions (for land-less families):
The food grain based participation in KAS can be obtained by giving 15 kgs of any
variety of wheat or 19 kgs of any variety of Bajra per family member as the annual
subscription of KAS. This facility would be available for billed treatment expense of up
to Rs.5000/- per person up to 5 members in a family. This will have to be deposited at
Shree Krishna Hospital.
Additional benefits for subscribers of KAS:

• For any family as a complete unit seeking participation in KAS a concession @10%
on annual subscription will be offered as an introductory offer.
• In case of non-utilisation of any services of KAS during the specified period, the
ceiling for the next year’s scheme is increased by 10%. This facility is offered for a
maximum of 2 years.
• A 10% concession on the diagnostic services during outpatient consultations,
ambulance facility and pathology services.
• A 5% discount on the medicines
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• The Maternity cases for normal treatments as well as for Caesarean cases are
accepted for the first two children for KAS subscribers.
• On a one time additional annual payment of Rs.50/per person, the KAS subscriber
may avail free OPD consultation services at SKH.
Scheme available for schools and colleges:

For school and college going students an annual subscription of Rs.50/- for
corresponding indoors-patient treatment expense coverage of Rs.5000/- for a year is
admissible. These students are entitled for an annual health check up by SKH doctors at
their respective education institutions for the year enrolled for.
Other salient features of KAS:

1. The facilities of KAS would become available from the 30 th day of payment of annual
subscription
2. Maternity cases for normal treatments as well as for Caesarean section are accepted
after 10 months from the payment of annual subscription for KAS.
3. Post treatment medicines for up to 7 days are provided as part of the scheme.
4. In case of chronic diseases like Diabetes, Hypertension etc the 1st instance i.e. when it is
detected for the first time during the scheme period, are treated under KAS provisions.
5. Treatment for certain diseases/ conditions has been excluded from the scheme:
 Benign Prostatic Hypertrophy, Hysterectomy for Menorrhagia or Fibromyoma,
Hernia, Hydrocele, Congenital Internal Diseases, Fistula in Anus, Piles, Sinusitis
are excluded during the first year of the membership. Covered from the second
year of KAS subscription.
 Any heart, kidney and circulatory disorders.
 The cost of spectacles, contact lenses and hearing aids.
 Dental treatment or surgery of any kind unless requiring hospitalization.
 Convalescence, general debility, ‘Run-down condition or rest cure, congenital
external disease or defects or anomalies, sterility, venereal disease, intentional
self-injury.
 HIV and related complications
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 Hormone replacement therapy.
 Renal dialysis, except where this is in connection with acute secondary failure and
is part of the intensive treatment.
 The treatment of psychiatric, mental or nervous conditions, insanity.
 Any cosmetic, plastic surgery, aesthetic or related treatment of any description,
whether or not for psychological reasons, unless medically necessary as a result of
an accident.
 Use of intoxicating drugs / alcohol and the treatment of alcoholism, solvent abuse,
drug abuse or any addiction and medical conditions resulting from, or related to,
such abuse or addiction.
 Taking of drug unless it is taken on proper medical advice and is not for the
treatment of drug addiction.
 Any fertility, sub-fertility or assisted conception operation.
 Joints replacement or any artificial organ transplantation.
MAIN PURPOSE OF THE STUDY:

The main purpose of this project was to make suggestions to make the social security
scheme KRUPA more acceptable to the community.
THE OBJECTIVES OF THE STUDY:

The objectives of the study were the following:
1) Find out the community’s perceptions about and expectations from the social security
scheme KRUPA.
2) Study other similar schemes and draw lessons from them.
3) Make suggestions on the basis of the above studies.
DECISION PROBLEM:
To assess the extent to which the social security scheme KRUPA is acceptable to the
community, and how to further improve its acceptability
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RESEARCH PROBLEM:
To study the perceptions and expectations of different decision-makers and develop
solutions to solve the problems.
SCOPE OF THE STUDY:

The study was conducted within the rural and urban areas of Anand district, within a
radius of 20 kilometers from the hospital. The study included those respondents who had
been exposed to KRUPA and those who hadn’t been exposed to it.
The sample in case of Non-KRUPA respondents may not be representative, because of
limitations of time and resources. Thus, the conclusions are, at best, indicative.
PRE-STUDY PREPARATION - ANALYSIS OF EARLIER STUDIES AND

OBSERVATIONS:
The objective of the scheme: To fulfill the healthcare needs (with main emphasis on
hospitalization needs) of the community (with special emphasis on poor community). The
sustainability factor has to be taken into account.
The following information available from the concept-testing study done before
designing the product in 2003:
1) People’s awareness and perception about Karamsad hospital:
a. Most people (about 96%) were found to be aware of the hospital.
b. In urban areas, 80% of the respondents agreed or strongly agreed that the
services offered by the hospital were very good. The percentage in the
rural areas was 77%.
c. Around 80% of the respondents in the urban areas agreed or strongly
agreed that the hospital was accessible to them. The percentage was 85 for
the rural areas.
d. Around 73% of the urban respondents agreed or strongly agreed that the
hospital has all the services required by them or in their words, “all the
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diseases can be treated at the Shree Krishna Hospital”. This figure was
found to be high in the rural areas. A total of 85% of the respondents were
of the opinion that all the services are available in the hospital.
e. 58% of the urban respondents agreed or strongly agreed that the hospital
provides services at lower costs than the private doctors. In rural areas, it
was around 59%.
f. 62% respondents in the urban areas found the behavior of the staff good.
In rural areas, 72% respondents thought so.
2) The level to which the product is needed in the first place
Desire to buy such a product: In the concept-testing study, it was discovered that
in the urban population, 54% of the overall respondents expressed a desire to
purchase such a product. Among the respondents in the low income group, the
53% respondents expressed this desire. The above percentages for the rural
community were 83% each for the overall and those with lower income level.
Willingness to pay: In the urban area, the average premium respondents were
willing to pay was about Rs. 1075 per year for a family of five. For the urban
respondents from the lower income group, the average was Rs. 515. In the rural
area, the average premium respondents were willing to pay was about Rs. 1143
per year for a family of five. For the rural respondents from the lower income
group, the average was Rs. 480.
3) The general health scenario in the region:
Annual Morbidity Rate = (Acute illness X 12) + Chronic illness + Hospitalisation
Class Acute Chronic Hospitalization Annual

(Income/month) morbidity*
A (>8000) 44.05 44.05 15.42 588.11
B (2501 to 61.78 54.92 38.90 835.24
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8000)
C (<=2500) 114.01 45.13 33.25 1446.56
Table 3: Morbidity profile of urban households
Class Acute Chronic Hospitalization Annual*
(Income/month) morbidity
A (>8000) 44.94 41.20 16.85 597.00
B (2501 to 56.84 61.05 35.79 778.00
8000)
C (<=2500) 83.52 47.40 36.12 1085.78
Table 4: Morbidity profile of rural households
* Per thousand population. This indicates the incidence of disease per thousand of
population.
4) The awareness about the health insurance amongst the people:

In rural areas, 53% of the respondents were found aware of something called
health insurance. But among the rural respondents in low income group, only 16%
respondents were aware of it. In the urban community, the percentages were 68%
and 49% for overall and low income community respectively. Low income in this
case is defined as someone earning less than or equal to the minimum wage rate.
Findings of students’ survey:

In the last phase of the concept testing exercises the concept was presented to the
students.
The major findings were:
- There was a high level of awareness about the hospital among the students. Out
of 50 students a total of 48 students had heard about the hospital.
- They gave a high ranking on all the five attributes namely, quality of services,
accessibility, behavior of staff, service availability and low costs. This indicates a
very good perception enjoyed by the hospital in the minds of the students.
- A total of 42 students out of 50 were willing to purchase the policy, but they
were not willing to go directly to the hospital and subscribe to it. They instead
wanted the policy to be sold to them through the educational institution, with the
premium added to their annual fee.
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- The most important reason for not subscribing to any of the current policies
was that the 32 students out of 50 said that they would rather pay the money out
of their pocket then indulge in the cumbersome procedural hassles of getting the
hospitalization charges reimbursed.
The following information, available from the pre-launch survey done after
the designing phase was complete:
After the design of the product was done, a pre-launch survey was carried out
with the purpose of gauging the reaction to the product and to make any changes,
if necessary.
The findings were as follows:

- 94% respondents in the rural areas were satisfied with the coverage.
- 92% respondents in the rural areas found the exclusions acceptable.
- About 96% respondents found the schemes to be affordable.
- About 98% people expressed satisfaction with the overall policy.
- More than 98% respondents expressed an intention of buying the policy.
The conclusions from the analysis of the prior studies:

The concept-testing and pre-launch studies done prior to the design and launch of the
product indicated:
1) The overall morbidity rate for the respondents from the lower income group was
found to be much higher than that for the respondents from the higher income groups.
But this difference in not very significant for hospitalization category diseases.
2) Among the respondents, the awareness about a health insurance product was just
satisfactory. But, such awareness was very low among the rural respondents from the
lower income group.
3) The premium decided by the product-designers was very close to the premium
desired by the respondents from the target community i.e. the rural and urban poor
community.
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4) During the concept-testing study, the willingness to buy such a product was found in
about half of the respondents in the urban areas and about 5/6th of the respondents in
the rural areas. Such willingness is found to be very high when the details of the
product are told to the respondents during the pre-launch study.
5) The overall perception about the product before the launch was very high and must
have been encouraging for those launching the product.
Observations and insights about the post-launch experiences obtained during early
interactions with the KRUPA team:
- The donors have played an important role in getting the people from the poor
community involved in the scheme. Some of the donors donate the money with some
conditions, like one of the donors insisted that 50% of the premium be collected from
the beneficiary.
- The institutions like companies and schools have also provided a bulk of members.
There needs also need to be looked into. Students and employees form a good part of
the potential membership base.
- The individually bought memberships from the lower income group form a small part
of the total membership base.
- The number of individually bought membership in any village is not even in three
digits.
- Overall rate of renewal is between 50-60%.
- The reasons for non-renewal are different for different people:
- Some buy the policy with a belief that they would be definitely getting something
in return of their premium. In face of non-usage, they find it useless to get the
policy renewed. Here, the perception about insurance in general may be the issue.
The tangible benefits are more important for them than the intangible ‘security’.
- Some others are dissatisfied with the outpatient coverage. Their expectations were
not in congruence with the reality.
- The exclusion conditions also disappoint some of the members.
- The bad experience in the hospital is also one of the reasons why some of them
don’t get the policy renewed
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- In some of the families, insurance doesn’t even exist on the priority list. Even a
small investment looks like a waste. They have a fatalist approach towards health
and healthcare.
- Bad word of mouth is also a reason cited for non-renewal. This is also an
important reason for less new membership in some areas.
- Single deliverer of service is a problem. Mediclaim services can be availed
anywhere.
- The VHCS scheme being offered by the hospital for the employees of the
industrial concerns is competing with KRUPA. The premium for this scheme is
higher, but the coverage is far higher than that in KRUPA. Thus, some people opt
for it.
METHODOLOGY:
We neither accepted nor rejected the validity of the data available from the earlier
surveys. But, we took it as a starting point and decided on what we needed to test again
and what new information we needed to seek from the community.
Our observations and conversations with the fieldworkers lead us to divide the field study
into 4 different types of decision-makers, with different concerns. These are:
1) Individual community members who decided for themselves and for their
families.
2) Donors who decided to donate for people from their areas of residence or people
belonging to certain economic class.
3) Schools that decided about the membership of their students.
4) Companies that decided about the membership of their employees.
All these decision makers had different concerns. Thus, we needed to decide on the
information we wanted to seek from each and how we wanted to seek it.
In case of individual community members, we decided to go for a survey with structured
questionnaires.
In case of the other three categories, we decided to go for unstructured interviews.
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We also decided on the information we needed to seek in order to come to a meaningful
understanding of the situation and what can be done to improve things.
Individual community members:

1) The sampling plan for the survey of general public:
I) KRUPA (90)
i) General Members who didn’t renew their membership (30)
ii) Members who got the membership renewed (30)
iii) The members who were initially enrolled from donation money (30)
II) Those members who availed of the In-patient services (30) (It is
technically a subset of I), but the purpose of this sample was different)
III) Non-KRUPA (120)
i) Rural poor (30)
ii) Rural non-poor (30)
iii) Urban poor (30)
iv) Urban non-poor (30)
We selected village randomly and according to distance i.e. 0-10 kms, 10- 15 kms, and
15-20 kms from hospital. The selection of village also depended upon the minimum
number of potential respondents for one or more categories. Please refer annexure for the
list of villages. For urban poor, we identified two slums, one is near to hospital (Borsad)
and another one is far from hospital (Near Station). For this category, respondents were
also selected randomly from city area of Anand and VV Nagar.
The individual community member-centered investigation was conducted through
questionnaires with some common questions for all respondents and some questions
particularly for that category or sub-category of respondent. Apart from the structured
questionnaire, stress was on having a short conversation with each respondent, with the
purpose of getting some insights about the issues the salience of which might not have
come to our notice.
The other investigations (donor, school and company-centered) were carried out by semi-
structured interviews with the people concerned.
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Information sought:
The questions were arranged in a hierarchical manner.
Some questions were common for all respondents. These were the questions about the
hospital and insurance in general.
Some others were common to the category of respondent, i.e. KRUPA, non-KRUPA and
IP service beneficiary.
The rest of the questions were specific to the sub-category, i.e. KRUPA renewal, KRUPA
non-renewal, and donor-benefited KRUPA members.
The following listing gives an account of all the information sought, in a hierarchical
manner:
1) Common for all respondents:
- Respondents’ health-seeking preferences in case of different types of diseases. We
grouped the diseases into 3 categories, on the basis of time taking to heal and the need
for hospitalization. The total number of instances of diseases in each category was
divided as per the preferences of health service providers.
- For those not preferring SK hospital: reasons for not preferring.
- The awareness and perception about the hospital, if they have used the services of the
hospital in the last 3 years. (In terms of accessibility, availability of services, quality
of services, expenses, and behavior of doctors and staff)
- Suggestions for improvement in the hospital.
- Awareness and perception about insurance in general and health insurance in
particular.
- Question about the intra-household preferred beneficiary.
1.1) Specific to all those respondents who have never been with KRUPA:
- Awareness about KRUPA.
- Opinion about premium, coverage etc.
- If they are aware of or are members of some other scheme: comparison with
KRUPA and the main reason for not choosing KRUPA over the other scheme.
- Suggestions for improvement in the scheme.
19
- For those who are aware but haven’t joined KRUPA or any other scheme: main
reasons for not joining. Changes that could make them buy the policy.
- Only those who are well aware of the scheme and its conditions: how much
extra premium they would be prepared to pay for: No exclusion? Two totally free
OP services?
1.2) Common for all those who have been or are with KRUPA:
- Source of information about the scheme.
- The instances of entire family enrollment.
- Level of awareness they have about the different conditions applicable to
KRUPA members
- Opinions about the scheme.
- How much extra premium would they be prepared to pay for: No exclusion?
Two totally free OP services?
- For those who availed of benefits: Their experience.
- For those who availed benefits before and after becoming member: comparison
of experience as a pre-KRUPA patient and as a KRUPA patient.
- Suggestions for improvement in the scheme.
1.2.1) Specific to the KRUPA member who didn’t renew the membership:
- Did they join some other scheme? If yes, compare that scheme with KRUPA.
- The most important reasons for leaving the scheme.
- If they had any specific bad experiences, elaborate on them.
- What changes in the scheme or the service provider could make them come
back to the scheme?
1.2.2) Specific to the KRUPA member who renewed the membership:

- The most lucrative features of the scheme that made them stay with the
scheme.
- Preference to go for higher inpatient coverage.
- Willingness to recommend the scheme to relatives/friends.
20
- Those who considered other schemes as well: Reasons for choosing KRUPA.
- Willingness to help promote KRUPA
1.2.3) Specific to the KRUPA member who were initiated using donations:
- Whether they got the membership renewed.
- For those who got the membership renewed: The main reasons that made
them take the renewal decision
- For those who didn’t get the membership renewed: The reasons for non-
renewal?
- The level of membership fee they are willing to pay.
1.3) Specific to IP beneficiaries under KRUPA:

- For those who visited SK hospital before becoming KRUPA members as well:
Comparison of their experiences as KRUPA members and before that; the best
features, based on their experience.
- The level to which KRUPA lived up to their expectations.
- Expectations of those who were not totally satisfied.
- Expectations in term of special privileges (non-economic) as KRUPA members
- For those who didn’t visit SK hospital before becoming KRUPA members:
Comparison of their experiences in other places where they went before coming
to SK hospital as KRUPA members with their experiences in SK hospital.
- The best features of the scheme.
- In absence of KRUPA: i) alternative sources of money for spending on
hospitalization, ii) alternative health service provider, iii) chances of not seeking
hospitalization.
- Willingness to pay more premium for: No exclusion, two free OP services.
- Intention of renewal and the reasons for positive or negative intentions.
- Willingness to help in promoting KRUPA.
FINDINGS FROM THE SURVEY:

Findings from the survey of individual community members:
21
The survey was conducted in the rural and urban areas within in 20 kilometers radius of
the hospital.
Wherever the answers are on a scale of 1 to 5, following it’s the corresponding response:
1: Strongly agree
2: Agree
3: Neither agree nor disagree
4: Disagree
5: Strongly disagree
Categorization of diseases:
With the consultation of two doctors, we categorized certain commonly occurring disease
on the basis of severity, duration of treatment and expense, into three categories. Please
refer the annexure for a list of diseases and categories.
The following are the summaries of the findings under different categories:
Non-KRUPA respondents:
Preference of hospital:
We are presenting here the data about preferences of the respondents for the entire
category of non-KRUPA respondents, followed by the disaggregated data for different
sub-categories. The reasons for not preferring are also given for different sub-categories
of respondents. The number of instances in different categories 2 and 3 of diseases for
different sub-categories of respondents was so small that it was hard to derive anything
from that. When the data are aggregated, the number of instances is large enough to help
us get some indication about the preferences.
Total for all non-KRUPA respondents:
All in all, it can be said that SK hospital is not a highly preferred destination for the
respondents in this category. The aggregate data for this category of respondents gives a
large enough sample to give an indication of this.
Category Preference SK hospital Others Total
1 1 14 84 98
2 15 83 98
2 1 3 22 25
22
2 4 21 25
3 1 11 21 32
2 11 21 32
All 1 28 127 155
2 30 125 155
Table 5: Healthcare seeking preference for Non-KRUPA respondents.
Total number not preferring: 61 Total number not preferring: 22 Total number not preferring: 15
For category 1: For category 2: For category 3:
Accessibility: 35 Accessibility: 12 Accessibility: 6
Quality of service: 18 Quality of service: 6 Quality of service: 15
Expenses: 41 Expenses: 15 Expenses: 7
Availability of services: 0 Availability of services: 0 Availability of services: 0
Behavior of doctors and Staff: 18 Behavior of doctors and staff: 6 Behavior of doctors and staff: 9
Other reasons: Other reasons: Other reasons:
Table 6: Reasons for not preferring SKH (for Non-KRUPA)
Urban Poor:
For category 1 diseases, SK hospital is not a preferred destination for most of the
patients in this category.
For category 2 and 3, the number of instances of diseases is too small to say
anything decisively.
Overall, the hospital is not a preferred destination for most respondents in this
sub-category.
Category Preference Private SK hospital Others Total
doctor
1 1 26 0 2 28
2 26 1 1 28
2 1 7 0 0 7
2 7 0 0 7
3 1 3 4 0 7
2 3 4 0 7
All 1 36 4 2 42
2 36 5 1 42
Table 7: Healthcare seeking preference for urban poor Non-KRUPA respondents
Total number not Total number not Total number not

preferring: 19 preferring: 7 preferring: 4
23
Accessibility: 12 Accessibility: 4 Accessibility:
Quality of service: Quality of service: Quality of service: 1
Availability of services: Availability of services: Availability of services:
Behavior of doctors and Behavior of doctors and Behavior of doctors and
Staff: 5 staff: 1 staff: 1
Table 8: Reasons for not preferring
Urban non-Poor:
For all the three categories, SK hospital is not a preferred destination for most of
the patients in this category.

doctor
1 1 28 0 0 28
2 28 0 0 28
2 1 8 1 0 9
2 8 1 0 9
3 1 6 1 1 8
2 5 0 3 8
All 1 42 2 1 45
2 41 1 3 45
Table 9: Healthcare seeking preference for urban non- poor Non-KRUPA
respondents
Total number 21 Total number 8 Total number 5

Accessibility: 20 Accessibility: 8 Accessibility: 4
Availability of
Availability of services: Availability of services: services:
Table 10: Reasons for not preferring (for urban non- poor Non-KRUPA
respondents)
24
Rural non-Poor:
For category 1, SK hospital is more preferred than for other categories.
For categories 2 and 3, the sample was very small, but for that sample the SK
hospital is not a preferred destination.
doctor
1 1 10 4 4 18
2 10 5 3 18
2 1 3 1 0 4
2 3 1 0 4
3 1 5 1 2 8
2 5 2 1 8
All 1 18 6 6 30
2 18 8 4 30
Table 11: Healthcare seeking preference for rural non-poor Non-KRUPA
respondents
Apprehensions about the quality of services are the most important reason for this group.
Table 12: Reasons for not preferring (for rural non-poor Non-KRUPA respondents)
Total people: 11 Total people: 4 Total people: 6

Accessibility: 2 Accessibility: Accessibility: 1
Expenses: 6 Expenses: 2 Expenses:
Rural Poor:
For category 1 diseases, SK hospital is preferred by a good part of the
respondents.
For category 2, the sample was very small, but within that sample SK hospital is
not the most preferred destination.
25
For category 3, the sample was very small, but within that sample SK hospital is
the most preferred destination for majority of people.
Category Preference Village SK hospital Others Total
doctor
1 1 12 10 2 24
2 11 9 4 24
2 1 1 1 3 5
2 0 2 3 5
3 1 1 5 3 9
2 1 5 3 9
All 1 14 16 8 38
2 12 16 10 38
Table 13: Healthcare seeking preference for rural poor Non-KRUPA respondents
Expenses are the most important reason for not preferring.

Total number: 10 Total number: 3 Total number: 4
Staff: 3 staff: staff: 1
Table 14: Reasons for not preferring (for rural poor Non-KRUPA respondents)
Perception about the hospital:

This part was asked only to those who had visited the hospital at least once in the last 3
years. The respondents were asked to respond to some statements indicating their
perceptions about the hospital in terms of different parameters. The responses had to be
recorded on a scale of 1 to 5.
The aggregated data is not being presented for the entire category because the number of
instances of eligible respondents in each sub-category is large enough to be at least
indicative of some broad perceptions within the category.
Urban poor:
26
Total number eligible to respond: 25
The main concerns for this sub-category appear to be expenses and accessibility.
1 2 3 4 5
i) Accessibility easy 6 8 11
ii) Quality of services excellent 2 9 10 4
iii) Availability of services complete 14 10 1
iv) Expenses lower than pvt hospital and clinics 4 5 14 2
v) Doctors and staff behaviour proper 14 5 6
Table 15: Perception about the hospital (Urban poor non-KRUPA)
Urban non-poor
The main concern for this sub-category appears to be accessibility.
1 2 3 4 5
ii) Quality of services excellent 1 11 8 6 1
iii) Availability of services complete 18 9
iv) Expenses lower than pvt hospital and clinics 13 6 8
v) Doctors and staff behaviour proper 15 5 6 1
Table 16: Perception about the hospital (Urban non-poor non-KRUPA)
Rural poor
These sub-category respondents are not very dissatisfied by any of the parameters, but
expenses are a concern for some of them.
1 2 3 4 5
i) Accessibility easy 4 15
27
Table 17: Perception about the hospital (rural poor non-KRUPA)
Rural non-poor
The main concerns for these sub-category respondents appear to be expenses and
behavior of the doctors and staff.
1 2 3 4 5
ii) Quality of services excellent 7 4 3
Table 18: Perception about the hospital (rural non-poor non-KRUPA)
Awareness and perception about insurance:

Number aware of insurance: - (all out of 30)
Urban poor: 11
Urban non-poor: 29
Rural poor: 6
Rural non-poor: 26
The awareness about insurance in general is quite low among the poor sections.
Number of those who have bought any insurance policy:

Urban poor: 3 (All LICs)
Urban non-poor: 25 (23 LICs)
Rural poor: 2 (Both LICs)
Rural non-poor: 24 (All LICs)
The number of respondents who have bought an insurance policy is low for the poor
sections.
Most of those who have bought any insurance policy have bought life insurance only.
This indicates that most people are not yet exposed to different kinds of insurance
policies available in the market.
28
Reasons for buying insurance:
Urban Poor Urban non-poor Rural poor Rural non-poor
(Total: 3) (Total: 25) (Total: 2) (Total: 24)
Security
coverage 3 25 2 23
As an
investment 0 19 0 15
Income tax
benefits 0 13 0 5
Other benefits 0 0 0 0
Table 19: Reasons for buying insurance (Non-KRUPA)
Security coverage is the most dominating reason for buying an insurance policy. But,
among the non-poor, investment and income tax benefits are also fairly important.
Awareness about KRUPA:

Number of respondents aware about KRUPA: (all out of 30)
Urban poor: 2
Urban non-poor: 8
Rural poor: 6
Rural non-poor: 3
This shows that there is a real problem of awareness about the scheme. There is an urgent
need to spread more awareness about the scheme.
For those who are aware of KRUPA: Reasons for not becoming members-
UP UNP RP RNP
i. Lack of willingness to pay the membership fee: 1 2
ii. Affordability of the membership fee:
iii. Only one service provider: 1 1 1
iv. Don’t think it is important to have such healthcare

security: 2 6 5 2
v. Already covered under some other scheme:
29
vi. Dissatisfaction with the coverage: 1
vii. Bad experiences with such schemes: 1
viii. Other reasons: 1
Table 20: Reasons for not becoming members (Non-KRUPA)
Among those who are aware of the scheme, the most important reason for not buying
appears to be that such a security is not a priority for them.
This calls for a need to spread a greater awareness, not just about the scheme but also
health insurance in general.
Perceptions about KRUPA:

There are two types of respondents in here:
1) Those who were aware of the scheme when we approached them. (Total: 18)
2) Those who had to be told about the scheme and its salient features. (Total: 102)
The following are their responses to the statements reflecting their perceptions about the
scheme in terms of different parameters:
The responses were recorded on a scale of 1 to 5.
Number not aware of the scheme: 18

1 2 3 4 5
1) Fee reasonable 8 10 0 0 0
2) Coverage acceptable 3 12 2 1 0
3) Exclusion criteria justified 0 0 13 5 0
4) Formalities minimal 4 13 1 0 0
Number aware of the scheme: 102

1 2 3 4 5
1) Fee reasonable 72 30 0 0 0
2) Coverage acceptable 27 72 0 3 0
3) Exclusion criteria justified 0 17 61 24 0
4) Formalities minimal 30 67 5 0 0
Table 21: Perceptions about KRUPA
Certain things that come out from the above data concerning the perceptions about
KRUPA:
30
- The fee is not a problem for most people.
- The coverage is also acceptable to most of the people from both the types.
- The exclusion criteria are troubling some of the people, especially all of those
who were already aware of the scheme.
- Most of the respondents didn’t have much of a problem with the formalities
involved.
This gives a positive sign for the scheme as such, but the exclusion criteria working as
deterring factors need to be looked into.
The suggestions for improvement:

The common suggestions coming from people are listed below. Only those suggestions
which came from more than 5 people are included in the list:
Note: It needs to be pointed out here that the Urban poor respondents overwhelmingly
liked the scheme and didn’t give any specific suggestions for improvements. Their main
concern is the accessibility of the service provider.
Suggestions for the scheme:

1) Less exclusion. May charge higher fee.
2) OP benefits at an extra membership fee.
3) Single card for the whole family.
Suggestions for the service provider:

1) More service providers should be included.
2) SK hospital should be less expensive.
3) The behavior the doctors and staff should be more friendly.
4) More facilities in Anand.
We also asked them a question about the frequency and quantum of fee payment, giving
them three options:
i. One time payment of fee
31
ii. 3 installments in 3 months (Rs. 30 each)
iii. 10 installments in 10 weeks (Rs. 9 each)
iv. 45 installments on alternate days (Rs. 2
each)
Only the rural and urban poor showed interest in any option other than the first one.
13 out of 30 urban poor respondents showed preference for the second option.
6 out of 30 rural poor respondents showed preference for the second option.
KRUPA respondents:
The members who didn’t renew the membership:

Preference of health providing facilities:
The number of instances of health-seeking needs for category 2 and 3 diseases is too
small to say anything. But, the overall indication is that the SK hospital is not a preferred
destination for this category of respondents. The fact that in 17 out of 20 instances of
diseases, the people preferred other health-providing facilities indicates of that.

1 1 1 12 13
2 1 12 13
2 1 1 1 2
2 1 1 2
3 1 1 4 5
2 1 4 5
All 1 3 17 20
2 3 17 20
Table 22: Healthcare seeking preference for non-renewing members
The sample is small, but the indication is in the direction of perception about expenses as
the most important reason for not preferring.
Number of those not

preferring 8 1 3
32
Staff: staff: staff:
Table 23: Reasons for not preferring (Non-renewing members)

This part was asked only to those who had visited the hospital at least once in the last
three years. Total number of eligible respondents was 12. This in itself is an indication of
low popularity. The results are listed below. The perception about expenses and
availability of services are the only low points, otherwise the perception of those visiting
the hospital is positive.
Perception about the hospital Total number: 12
1 2 3 4 5
ii) Quality of services excellent 11 1
iv) Expenses lower than private hospital and clinics 4 2 6
v) Doctors and staff behavior proper 1 8 1 2
Table 24: Perception about the hospital (Non-renewing members)
Reasons for buying an insurance policy:

i) Security coverage 28
ii) As an investment 9
iii) Income tax benefits 5
iv) Other benefits
Table 25: Reasons for buying an insurance policy (Non-renewing members)
Source of information about the scheme:

The only source of information about the scheme for all these people was KRUPA staff.
This indicates the limited effects of other awareness spreading efforts.
Source of info about scheme:
KRUPA staff 30
Number for whom the entire family was 12
33
insured:
Perception about the scheme:

The main trouble appears to be the limited OP coverage and exclusion criteria. Otherwise
the scheme is acceptable to most people.
1 2 3 4 5
1) Fee reasonable 12 18
2) OP Coverage acceptable 9 4 17
3) IP Coverage acceptable 26 4
4) Exclusion criteria justified 1 18 11
5) Formalities minimal 14 16
Table 26: Perception about the scheme (non-renewing members)
For those non-renewing members who availed of the services:

The following part was asked only to those non-renewing members who availed of the
services.
The data shows that most people didn’t find availing the services as a KRUPA member
easy. Moreover, most members were not satisfied with the coverage provided. Some of
these were under the OP services, so the less coverage under OP may be the reason for
this opinion.
Among those who had visited the hospital both before and after becoming members, the
experience after becoming a member was not special as compared with the experience
during the pre-membership visits.
Number of those who availed the benefits: 7

1 2 3 4 5
Easy to avail benefits as members: 4 3
Satisfied with the coverage for the fee 1 1 5
Number of those who visited before becoming

members :4
1 2 3 4 5
Easier to avail services 4
Felt more privileged 2 2
Table 27: Experience while availing benefits (non-renewing members)
34
The most important reason for leaving the scheme:
The most important reason turns out to be dissatisfaction with the coverage, especially
OP coverage. The second important reason is the belief that such a scheme is not
important for them.
i) Lack of willingness to pay the membership fee:
ii) Affordability of the membership fee: 2
iii) Only one service provider:
iv) Don’t think it is important to have such healthcare security: 7
v) Already covered under some other scheme: 3
vi) Dissatisfaction with the coverage: 13
vii) Bad experiences as a member:
viii) Migrated elsewhere 2
ix) No follow-up 2
x) Didn't know about renewal 1
Table 28: Reasons for leaving the scheme (non-renewing members)
For those who joined some other scheme after leaving KRUPA:
The following are the points on which they find the chosen scheme better than KRUPA:
Number who joined some other scheme: 3
Name of the scheme Better features
Mediclaim Treatment anywhere 3
Income tax benefit 1
Suggestions for improving the scheme:

The following are the suggestions for improving the scheme, along with the number of
people making those suggestions.
Increase OP benefit 18
No exclusion 8
Scheme good (other
probs) 6
No suggestions 5
Those members who got the membership renewed:
Preference of health-service providers:
35
There was no instance of category 2 disease among the respondents. The overall picture
indicates that SK hospital is the most preferred destination for the respondents in this
category.
1 1 5 4 9
2 5 4 9
2 1 0 0 0
2 0 0 0
3 1 7 2 9
2 7 2 9
All 1 12 6 18
2 12 6 18
Table 29: Preference of health-service providers (renewing members)

The SK hospital enjoys a good perception among most of the respondents, as can be seen
from the following responses.
1 2 3 4 5
ii) Quality of services excellent 2 18
Table 30: Perception about the hospital (renewing members)
Reasons for buying insurance:

The biggest reason driving the decision of going for insurance turns out to be a want for
security coverage.
i) Security coverage 30
ii) As an investment 12
iii) Income tax benefits 5
iv) Other benefits 0
Table 31: Reasons for buying insurance (renewing members)
Sources of information about KRUPA:

Almost all the respondents in this category came to know about the scheme from the
KRUPA staff only.
36
KRUPA staff 29
Relative 1
Number for whom the entire family was insured:

Almost half of the respondents had their entire families insured.
Number for whom the entire family was insured: 14

The scheme enjoys a good reputation, but some people have problems with OP coverage
and exclusion criteria.
1 2 3 4 5
3) IP Coverag acceptable 12 18
6) Renewal easy 26 4
Table 32: Perception about the scheme (renewing members)
Willingness to pay for two free OP services and no exclusion:

23 out of the 30 respondents were willing to pay extra fee for these services. They were
willing to pay in the range of Rs. 20 to Rs. 60 in addition to the basic fee, depending on
the services they are getting.
Experiences of those who availed benefits:

Number of respondents who availed benefits: 8
For almost all the respondents the experience was pleasant. They found it easy to avail
the benefits, and were satisfied with the coverage.
1 2 3 4 5
Easy to avail benefits as members 8
Satisfied with the coverage for the fee 7 1
Table 33: Experiences of those who availed benefits (renewing members)
Experiences of those who availed the benefits before and after becoming KRUPA
members:
37
Here, all the respondents found it easier to avail benefits as KRUPA members than they
did when they were not KRUPA members. This was mainly due to the transaction being
cashless. But, they didn’t feel more privileged in comparison to their earlier visits as non-
KRUPA members.
1 2 3 4 5
Felt more privileged 4
Table 34: Experiences of those who availed the benefits before and after becoming
KRUPA members (renewing members)
Those members who took In-patient benefits:

Some respondents were ambivalent about the availability of services and expenses, but
the overall perception can be said to be positive. Very few people actually gave
“disagree” as a response, and none responded in strong disagreement.
1 2 3 4 5
iv) Expenses lower than pvt hospital and clinics 1 14 12 3
Table 35: Perception about the hospital (IP beneficiaries)

The OP coverage and exclusion criteria are the only low points. Otherwise, the scheme
enjoys a good perception.
1 2 3 4 5
2) OP Coverage acceptable 1 17 4 8
3) IP Coverage acceptable 6 22 2
4) Exclusion criteria justified 21 9
38
6) Renewal easy Total: 24 9 15
Table 36: Perception about the scheme (IP beneficiaries)
Source of spending in absence of KRUPA coverage:

Savings: 25
Debt: 5
Experience while taking services as KRUPA member:

Most of the respondents found it easy to avail the services as KRUPA members.
Most were also satisfied with the coverage they received.
1 2 3 4 5
Easy to avail benefits as members: 4 23 2 1
Satisfied with the coverage for the fee 1 26 1 2
Table 37: Experience while taking services as KRUPA member (IP beneficiaries)
Experiences of those who visited the hospital both before and after becoming members of
KRUPA:
Total number of such members: 25
When asked to compare the experiences before and after becoming members, most
respondents didn’t say they felt more privileged as KRUPA members than they did when
they visited as non-members. Almost half of the respondents also didn’t agree that it was
easier for them to avail services as KRUPA members.
1 2 3 4 5
Easier to avail services 13 11 1
Felt more privileged 6 18 1
Table 38: Experiences of those who visited the hospital both before and after
becoming members of KRUPA (IP beneficiaries)
Experiences of those who did not visit the hospital before becoming members:
Total number of such members: 5
1 2 3 4 5
More convenient to avail services in SK
hospital than at the earlier place: 3 2
39
Table 39: Experiences of those who did not visit the hospital before becoming
members (IP beneficiaries)
Overall satisfaction over the decision of becoming a member:

The response to this question was overwhelmingly positive. An important reason bviouslt
is that they were able to avail of benefits.
1 2 3 4 5
Happy about the decision of joining 6 23 1
Table 40: Overall satisfaction over the decision of becoming a member (IP
beneficiaries)
For those who had earlier been with some other scheme:
Only one member had earlier been with another scheme. He had been with Mediclaim
earlier. He said that Mediclaim was not easy to use and involved hassles of claim etc.
Number of those with intentions to renew the membership: 24
Willingness to pay extra fee for two free OP services and very limited exclusion:
20 respondents were willing to pay extra fee for these additions in the scheme. The range
of desired payment was from Rs. 20 to Rs. 110.
Number of those willing to popularize the scheme: 28

Most of them claim that they have already recommended the scheme to their friends and
relatives.
Donor benefited members:

Preference of health providing facilities:
The hospital is the single most preferred healthcare seeking destination for the
respondents in this category. It was discovered that one important reason for this is that
they got benefits as KRUPA members.
40
1 1 3 10 13
2 3 10 13
2 1 1 1
2 1 1
3 1 9 3 12
2 9 3 12
All 1 13 13 26
2 13 13 26
Table 41: Preference of health providing facilities (donor benefited)
Reasons for not preferring SK hospital:

The main reason for not preferring was the fear of high expenses. Most of these cases
came under those categories of diseases that are not covered under KRUPA or under OP.
Number of those
not preferring
For category 1: 10 For category 2: For category 3: 3
Accessibility: 2 Accessibility: Accessibility:
Quality of service: Quality of service: Quality of service: 1
Expenses: 9 Expenses: Expenses: 1
Availability of
Availability of services: services: Availability of services: 1
Behavior of doctors and Behavior of doctors Behavior of doctors and
staff: and staff: staff:
Other reasons: 1 Other reasons: Other reasons:
Table 42: Reasons for not preferring SK hospital (donor benefited)

This part was asked only to those who had visited the hospital at least once in the last
three years. Total number of eligible respondents was 18.
The hospital enjoys a good reputation among the respondents. Only one the questions
related with expenses there seems to be some concern, otherwise it is good.
1 2 3 4 5
ii) Quality of services excellent 6 11 1
41
v) Doctors and staff behaviour proper 4 14
Table 43: Perception about the hospital (donor benefited)
Number of those who have bought any other insurance scheme: 1 (LIC)
This low number indicates that the people are not very well aware of the insurance
schemes or that it is not their priority. The fact that they have been initiated into KRUPA
through donors’ money and still most of them wish to continue on their own shows that
once they become aware of the benefits, they may choose to stay. The main thing is
initiation.

Here also, OP coverage and exclusion criteria are the main concerns for the people.
1 2 3 4 5
3) IP Coverag acceptable 13 16 1
6) Renewal easy 26 4
Table 44: Perception about the scheme (donor benefited)
For those who availed the benefits:

Total number of such respondents: 10
The respondents were satisfied with their experience while availing benefits.
1 2 3 4 5
Easy to avail benefits as members: 9 1
Satisfied with the coverage for the fee 10
Table 45: Experience while availing benefits (donor benefited)
For those who visited both before and after becoming members:
Total number of such respondents: 2
1 2 3 4 5
Felt more privileged 2
Table 46: Experience of those who visited both before and after becoming members
(donor benefited)
42
Number of those who have got the membership renewed or plan to get it renewed: 26
26 out of 30 is a good score because this time they were asked whether they would pay
out of their own pockets to get the membership renewed.
Findings from schools:
We went to four schools, 2 of which are in rural areas and the other two in urban area.
2 of the schools were enrolled under KRUPA, while the other two were not enrolled.
Following are the names of the schools:
Rural
 Primary girls school (Mogri) - Enrolled
 Smt. C. J. Patel English Medium School ( Karamsad)- Not enrolled
Urban
 B.S.W. Anand Institute of Social Work (Anand)- Enrolled
 M. S. Mistry school ( V V Nagar)- Not enrolled
Findings:
Need special attention for students in terms of priority in consultation.
OP benefit: Discount on medicine should be more
For some schools hospital is not acceptable destination
Students claimed: Staff does not behave properly.
Findings from companies:

We went to five companies, two of which are not enrolled under KRUPA, while the other
three are enrolled. The following are the names of the companies:
Not enrolled
Creamy biscuit pvt. Ltd. (GIDC)
Kripali Industries ( plot no-19, GIDC )
Findings: The reason why they are not enrolled is because both of them are already
enrolled under VHCS scheme run by GIDC. We also found out that this is the reason for
most other companies not enrolling under KRUPA. The coverage under VHCS is very
43
high and the payment is partially done by GIDC. VHCS is run on a high deficit, just to
give more benefits.
Enrolled
Tripicon Engineering Pvt. Ltd. (plot-1115, GIDC-IV)
Swiss Glas-Coat Pvt. Ltd. (GIDC-IV)
GMM pfaudler reactor Pvt. Ltd. (GIDC, Sojitra road)
Findings: The main expectations that came out of the interviews were: More OPD
benefits and group insurance. Group insurance is expected because sometimes the
employees are hired for less than a year. Thus, the premium for such employees goes
waste.
Summary of the main findings from the field study:

• Non-KRUPA respondents:
– Except rural poor, the hospital was not found to be a preferred healthcare-
seeking destination for most respondents.
– For rural respondents and urban poor respondents, fear of high expenses is the
main deterring factor.
– For urban respondents, accessibility is the main issue.
– Low level of awareness about insurance in general among the respondents
from economically poor background.
– There is a very low level of awareness about KRUPA among all sub-
categories within this category.
– When told about the scheme, they found everything except the exclusion
acceptable.
• Members who took In-patient benefits
– Overall perception about the hospital was positive
– About the scheme: OP coverage and exclusions were troubling most
– Experience while availing benefits: Most found it easier because it is cashless,
but did not feel more privileged than they did when they visited as Non-
KRUPA patients.
44
– Most were willing to pay extra for higher OP coverage and minimal
exclusions.
• The members who did not renew the membership:
– SK hospital is not a preferred destination for most respondents.
– The scheme is acceptable if the OP coverage is increased and exclusions
reduced, even at extra fee.
– Most people didn’t find more privileged availing services as KRUPA members
than they did before becoming members.
– The most important reasons for leaving the scheme:
• Dissatisfaction over coverage and exclusions.
• Such security is not a priority.
• Those members who got the membership renewed
– The SK hospital is the most preferred healthcare-seeking destination for most
respondents.
– Most understand the importance of such security, thus renewed in spite of not
taking benefits.
– Most were very pleased with the scheme, except on OP coverage and
exclusions. Most were willing to pay extra fee for more OP coverage and less
exclusions
– The experience while taking benefits was pleasant, but they didn’t feel more
privileged than they did while visiting as non-KRUPA patients.
• Donor benefited members
– SKH is the single most preferred destination. Reason : They got benefits as
KRUPA members.
– Only on the questions related with expenses there seems to be some concern,
otherwise the perception about hospital is good.
– Perception about the scheme: OP coverage and exclusion criteria are the main
concerns for the people
– Those who availed the services were satisfied with their experience while
availing benefits.
45
– Number of those who have got the membership renewed or plan to get it
renewed: 26
Findings from schools:

Need special attention for students
OP benefit: More discount
For some schools hospital is not an acceptable destination because of distance
Some students claimed: Staff does not behave properly.
Findings from Companies:

Reason for not enrolling was that they are enrolled in VHCS
The companies want higher OPD benefits and group insurance.
Now, keeping in mind the problems and expectations found from the field study, we
studied the other similar schemes.
STUDY OF OTHER SCHEMES AND SUGGESTIONS:

The study of other schemes was undertaken with the purpose of finding ways of finding
solutions to the problems found from the field study, finding ways of fulfilling
expectations of the decision-makers contacted during the field study, and finding
innovative steps that could be taken to make the scheme more acceptable.
Schemes under all the three models were studied, but with different purposes in mind.
The purpose of studying schemes of a particular type is discussed under the heading of
each model. Most of the suggestions were derived from this study. In additions to these,
some suggestions were derived from our own observations and insights gained from
various interactions we had.
Provider model:
This is the model in which KRUPA falls. The schemes under this model were studied
very closely, looking for innovative ways to improve the acceptability of KRUPA in the
community and to look for solutions to the problems discovered during the field study.
46
The suggestions coming out from the study of the schemes of this model do not require
any change in the basic design model of the scheme and SKAT.
In this model, four schemes were studied. The following are the names of these schemes,
along with some brief information about them:
1) The ACCORD-AMS-ASHWINI Health Insurance

This scheme is managed by three organizations, ACCORD- an NGO; AMS- the
tribal union and ASHWINI – a health provider. ACCORD is the parent NGO,
while ASHWINI is its sister concern.
It provides health insurance coverage to all the tribal members of the AMS living
in the Gudalur Taluk.
2) Medical Aid Plan of Voluntary Health Services – Chennai

VHS, a noted NGO, provides healthcare through a referral hospital (VHS
Hospital and Medical Centre) and a network of 14 mini-health centers (MHCs).
3) The Jawar health assurance scheme

This scheme is run by Mahatma Gandhi Institute of Medical Sciences, Wadha. It
is one of the earliest schemes in which the contribution was collected in kind to
ensure access to timely healthcare service. The basic principle of the scheme is
that everyone should have access to healthcare as per their ability to pay, but
everyone must contribute to it as per the ability to pay. Hence, it is known as an
assurance scheme.
One special thing about this scheme is that it is built on altruistic principles. It
may not be easy or even feasible to take lessons directly from it; but some
innovative methods of reaching out to the community can be employed.
4) The Student’s health home – Kolkata

Initiated in 1952, this is the oldest community based health insurance programme
in our country. The target community is students from Class V to University level.
The units of enrolment are the schools/colleges. This helps in risk pooling.
47
Suggestions:
The following are some of the suggestion which if worked on, can help in
improving the acceptability of KRUPA in the community. The suggestions are
grouped as per the objective they would achieve. The first 16 suggestions came
from the study of other schemes of the provider model:
For tying up with an insurance company
Tying up with an insurance company can move some of the risk away from the
organization and place it with an insurance company. The scheme can also benefit
from the various special packages available from the companies. The following
three suggestions are concerned with benefiting from such a step.
i) The design with an insurance company as the prime insurer: Within the
insurer model, it is possible to go for a prime insurer. SKAT can consider
minimizing its risk by the use of such a design. For example, the ACCORD-
AMS-ASHWINI scheme has to be viewed at two levels. One level is the
arrangement between ACCORD/ASHWINI and the insurance company, and
the other level is the arrangement between the tribal community (AMS) and
ACCORD/ASHWINI. The premium, benefit package and administration vary
for these two levels. The following is the design:
Royal Sundaram Insurance Company

R
P E
C
R I
L
E M
A
M B
I
I U
M
U R
S
M
ACCORD ASHWINI
C
P A
R R
E E
M
I
U
M
COMMUNITY
(Members of the AMS union)
48
Figure 2: The design of the ACCORD-AMS-ASHWINI health insurance
scheme.
ii) Long term and group discount from the insurance company: In the ACCORD
scheme, the members were insured in groups and for a period of five year.
This entitled them for long term and group discounts. The group and family
insurance also minimize the problem of adverse selection. This can be done by
SKAT if it chooses to go for a prime insurer.
iii) Upfront payment of premium from the NGO to the company and annual
payment by members to the NGO: ACCORD/ASHWINI insured tribals en
masse with the formal insurance company and paid their premiums upfront;
the tribals repaid this premium on an annual basis. This can be done by
KRUPA in order to insure people from very poor sections of the community.
But, this would need the involvement of a community-based organization, as
mentioned in the next point.
For improving awareness and community involvement:

There is a need to improve the awareness about the scheme and the community
involvement in the hospital and its activities. The field study showed some
awareness-related problems. The following two steps can be taken to improve
awareness and community involvement:
iv) Active involvement of a community-based organization: Even though in this
model the community involvement is not very high because hospital is in
charge and is usually too technocratic, but most of the good community based
health insurance schemes are characterized by a very active involvement by a
community-based organization. This involvement helps in doing something of
the kind mentioned in the above point. Moreover, it helps in building trust for
the scheme in the community. For example, for the ACCORD-AMS-
ASHWINI scheme, the premium collection is done both by the field staff of
ASHWINI and ACCORD, as well as the AMS leaders. Moreover, the AMS is
49
a respected organization of the tribals, making it very easy to create trust in
the population. SKAT would sooner or later need to involve a community-
based organization, like an NGO, on the basis of incentive. This would also
improve the current marketing tactics employed for the scheme. Moreover,
they could also go for tying up with some trade unions, cooperatives etc.
v) Going beyond the hospitalization coverage: All the schemes studied under this
category have tried to go beyond just the hospitalization coverage. Some have
tried to provide some primary and tertiary level care, and some have made
active attempts to go into preventive and promotive healthcare as well. For
example, the formal insurance company provides a hospitalization package,
but ASHWINI uses its resources to provide a more holistic coverage. External
resources are used for meeting the difference in the benefits package. As
ASHWINI provides comprehensive care, it provides people to live and to seek
care at the earliest when ill. This cuts down morbidity, making it a win-win
situation. Another example is the use of village health workers for providing
primary healthcare services under the Jawar health assurance scheme,
described in the following point.
For reaching out to the community with more services and for increasing the depth of
involvement
Most of the scheme we studied had a very deep involvement of the local community
in the scheme and the provider’s activities. Thy formed an important part of the lives
of the people. The steps suggested to this end are strategic in nature and would entail
some initial heavy investment on the part of the organization. Recruiting village
health volunteers and setting up Mini Health Centers are such steps. But, we need to
understand that these steps can go a very long way in getting community involvement
increased in the hospital’s and scheme’s activities.
vi) The use of Village Health Volunteers for collection of premium and for
providing primary health care: The Jawar health assurance scheme uses
village health workers for collecting premium; they are also provided with
drug kits for providing primary health care to the members. This leaves only
50
secondary and tertiary care to the hospital. This helps in a deeper penetration
into the community and makes the scheme the main part of their health-related
behavior. SKAT could tie up with a community-based institution and with
their help depute some local people as such workers. This need not be done on
one person per village basis. It can also be done on cluster basis. This can take
the scheme deeper into the community.
vii) The maintenance of a village savings account: This is an extension of the
above point. In the Jawar health assurance scheme, the collection of premium
is deposited in the village fund. This fund pays for the remuneration of the
VHW, to manage the drug kit, to meet the fuel expenses of the vehicle for the
village visit and to arrange village level meetings. The MGIMS receives co-
payments from members for providing secondary and tertiary care. This kind
of an arrangement makes it a village-level affair. The chances of villagers
enrolling en masse are improved. This method can be used by SKAT, if it is
able to partner with some community-based organization or the Panchayats.
This could help in making a village as a unit or enrolment. A village as a unit
of enrolment is very useful for reducing the chances of adverse selection. The
problem could be that since the AMUL members already get benefits through
the Tribhuvandas Foundation, it will take substantial effort and higher benefits
to get the people to join en masse. A village level fund and a nearby VHW can
do this for SKAT.
viii) The MHC pattern of spreading accessibility for the people: The 14 Mini-
Health Centres (MHCs) that support this establishment are manned by 2
Multi-purpose workers (MPWs) and provide curative and preventive care to
the 6000-10000 population in their catchment area. The MPWs work closely
with Lay First Aiders (LFAs) who are equivalent to Village Health Workers
and provide promotive health care in the villages. From our point of view, this
kind of a penetration can be very useful, not just for the scheme but also for
the hospital’s long-term share in the health-seeking preferences of the people.
The hospital already has two extension centres. They can be more properly
equipped. Moreover, smaller centres can be set up for far and wide reach.
51
For making the scheme more flexible
The present format of the scheme leaves very little room for the members to make
choice about what they want. Our field study also showed that many of them are
prepared to pay more for more services. Considering the following five steps could
help the scheme in increasing the flexibility of the scheme.
ix) Variable premium depending upon the reported family income: The SKAT has
a policy of subsidizing the premium for some members from the poor
community by using the donors’ money. This is a good way of getting them
initiated into the scheme. This can be formalized and used to make the scheme
appear more approachable for the members of the economically backward
community. An example of this type is the Medical Aid Plan of Voluntary
health Services. It takes variable premium from people depending on their
reported family income. The people are divided into 5 categories. The
members from the 3 categories of lowest income people receive subsidies
from donations. In our case, the basis of categorization can be different, but
the concept of variable premium can be tested.
x) Variable benefit package: The variable benefit packages can be used by SKAT
for ensuring that the members from the poorest sections of the society can be
given more care in cases in which the chances of their going into abject
poverty due to expenses are high. Such a variable benefit package can be used
for increasing flexibility in the scheme and providing the potential members
with option for joining the scheme for different types and levels of benefit
packages. The Medical Aid Plan of Voluntary health Services provides
variable benefits to different members, depending on their category.
xi) The concept of charging just the cost for certain services: The concept of
charging just the cost for certain services can be used for giving higher benefit
to in OP category and for some excluded categories. It would minimize the
losses, but give some benefits to the members. For example, the Medical Aid
52
Plan of Voluntary health Services charges just the cost in certain cases,
without any mark-up. This helps in ensuring that they don’t suffer losses and
at the same time, the members get a benefit.
xii) Flexibility of time period of membership: People should be allowed to buy
security for more than one year. Presently, they can wither buy for one year or
for lifetime.
xiii) Allow people to buy healthcare security for their old age during their working
life: Installment-based collection of premium from working people to provide
them insurance in their old age is a good way of attracting more long term
members.
For giving more benefits to the members, especially the needy:

High number of exclusions and less Out Patient (OP) benefits were found to be
universally disliked among the respondents. If exploration is done, there may be a
scope to minimize these limitations of benefits.
xiv) Very limited exclusions: All the community health insurance schemes of the
provider model are characterized by minimum exclusions or no exclusions at
all. Exclusions generally go against the logic of healthcare. They should be
minimized to the extent possible. In case of SKAT, the exclusion criteria were
roughly based on those from a commercial health insurance scheme. The
considerations for a commercial scheme are very different from those for a
community-based scheme. This needs to be understood and proper steps taken
in this direction.
xv) OP benefits as well: in all the provider model schemes, some kind of OP
benefits are included. While taking decisions of joining or not joining, the
people tend to think in immediate terms. The most frequent needs are in the
OP category. Our survey study has also shown that for most diseases in this
category, the hospital is not a preferred destination. Thus, an improved
coverage in OP can help not just the scheme in getting members, but also the
hospital in making it a preferred destination for healthcare seeking for such
53
diseases. Extra fee can be charged for such benefits, if they are to be made
totally free.
xvi) Special care of the poorest of the poor: The very poor sections of the society
invariably fall through the safety net. Some of the Community health
insurance schemes have initiated informal mechanisms to cover this
vulnerable section. At ACCORD, some better off people are requested to pay
extra and this is used to pay the premiums of the destitute.
For internal improvements:

There are certain internal improvement steps that can be taken in order to improve the
acceptability of the scheme. These steps do not require taking steps external to the
current setup. They just need incremental changes in what is done and the way it is
done.
xvii) Make KRUPA a priority: Sometimes, the administration comes up with the
schemes which hurt the possibilities of KRUPA. These schemes, in the short
run, provide huge benefits which make KRUPA appear to be useless. Such
steps that conflict with KRUPA should be avoided
xviii) Develop the Anand and Petlad extension centers and position them, especially
the Anand center as a destination for the poor and middle class. This could
help in taking care of the accessibility concerns of the people from Anand and
Vidyanagar.
xix) Students should be referred to an experienced consultant on a priority. Schools
provide bulk memberships and they ask for some special treatment. This could
be considered.
xx) Single membership card for a family: It becomes hard to maintain separate
card for different family members. Providing single membership cards for
families could be considered.
xxi) The receipt should be provided with a break-up of expenses for different
services. Some people complained that they don’t get break-up of their
expenses in the hospital.
54
For trying up with other hospitals for providing services:
xxii) Check the possibilities of tie up with hospitals in Khambhat, Nadiad etc. We
checked with two such hospitals. Following are the findings.
Findings from hospitals

We visited two hospitals to assess their interest in a tie-up with a community-based health
insurance scheme. The following are the details of the hospitals and the findings.
Khambat General Hospital, Khambat

 Total beds: 160
 Capacity utilization: 41% approx.
 Doctors: 14 (permanent), 07 (visiting)
 Staff: 80
 Collaboration for medical care: ONGC staff, ESI, SPAM.
Maha Gujarat Hospital, Nadiad
 Total beds: 125
 Capacity utilization: 60% approx.
 Doctors: 16 (permanent), 14 (visiting)
 Staff: 95
 Collaboration for medical care: SEWA. A good experience for them
Expectations if collaboration happens:
Hassle free reimbursement of claims
Charge according to rate fixed by hospital
Patient input should increase by approx 5% (IP and OP)
The other two models of Community Health Insurance:

KRUPA is a scheme coming under the Provider Model of community health insurance.
The direction that SKAT is moving is one of improvement and increased community
membership base. If some more good steps are taken, it won’t be long before the
55
catchment areas membership base will be close to the potential membership base. This
would need the policy makers of SKAT to take a decision: Whether to remain within the
same catchment area and improve the services as much as possible; or to scale up the
operations and move to more distant catchment areas, again constantly improving what is
being done. The decision can be taken even before the catchment area has been tapped up
to the potential. Whatever may be the case, such a decision would involve a serious
strategic stand-taking on the part of the policymakers of KRUPA. Depending on the
decision, the future course of action would have top be decided. Presuming that the latter
decision is taken, we studied some schemes of the models 2 and 3 of the Community
Health Insurance. The purpose of studying these schemes was to bring about the pros and
cons of switching from one model to another, so that the policymakers can take informed
decisions in this matter.
The following are the point that came out from a literature study of the schemes coming
under insurer and linked models:
Parameter Provider model Insurer model Linked model
Flexibility to Very flexible Depends on the insurance
suit local needs company’s products
Premium Set by NGO, Set by NGO, Set by insurance company
considering considering and based on actuarial
affordability affordability calculations
Coverage Can be made very Can be made very Traditional policy with its
comprehensive, based comprehensive, exclusions and limitations.
on needs based on needs
Risk With the NGO With the NGO With the insurance company
Quality of care Can be better because Can be better because No difference for insured and
of closeness between of closeness between non-insured patients
NGO and provider NGO and provider
Community Minimal as the Depends on the NGO Depends on the NGO
involvement hospital is in charge
and is usually
technocratic.
Exceptions are there.
Number of Usually only one main Can be many Can be many
56
providers provider
Claims and Generally cashless Mixed Mostly reimbursements.
reimbursements
Category Name of Disease
1 Common cold, fever, dysentery, peptic ulcer
(mild), worm infection, diarrohea, cholera,
acidity, common dental problem, viral infection,
nausea, vomiting, etc.
2 Malaria, pneumonia, kala ajar, sinusitis, VD,
bronchitis, surgical excision, hepatic infection,
appendicitis, fistulaa, etc.
3 Diabetics I & II, hypertension, TB, cardiac
problem, cerebral fever, cerebral TB, goiter,
ophthalmic complication (except infection),
falaria, unbalanced hormone secretion,
orthopedic, acute VD, cancer (various type),
renal problem, acute hepatic malfunction, organ
transplant, HIV infection, etc.
ANNEXURE:
57

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INTRODUCTION TO COMMUNITY HEALTH INSURANCE

The basic designs:

PROVIDER MODEL INSURER MODEL LINKED MODEL

Legal form of SKAT:

Objectives of the trust:

Krupa Arogya Suraksha (KAS):

Eligibility to become member:

Indoor Patient 46 yrs to 6061 yrs to 70

Sl. Indoor patient treatment expenses up to the One time subscription

Subscription for KAS in food grain contributions (for land-less families):

Additional benefits for subscribers of KAS:

Scheme available for schools and colleges:

Other salient features of KAS:

MAIN PURPOSE OF THE STUDY:

THE OBJECTIVES OF THE STUDY:

SCOPE OF THE STUDY:

PRE-STUDY PREPARATION - ANALYSIS OF EARLIER STUDIES AND

Class Acute Chronic Hospitalization Annual

4) The awareness about the health insurance amongst the people:

Findings of students’ survey:

The findings were as follows:

The conclusions from the analysis of the prior studies:

Individual community members:

1.2.2) Specific to the KRUPA member who renewed the membership:

1.3) Specific to IP beneficiaries under KRUPA:

FINDINGS FROM THE SURVEY:

Total number not Total number not Total number not

Category Preference Private SK hospital Others Total

Total number 21 Total number 8 Total number 5

For category 1: For category 2: For category 3:

Expenses are the most important reason for not preferring.

Perception about the hospital:

Table 15: Perception about the hospital (Urban poor non-KRUPA)

Awareness and perception about insurance:

Number of those who have bought any insurance policy:

Awareness about KRUPA:

iii. Only one service provider: 1 1 1

iv. Don’t think it is important to have such healthcare

Perceptions about KRUPA:

Number not aware of the scheme: 18

Number aware of the scheme: 102

The suggestions for improvement:

Suggestions for the scheme:

Suggestions for the service provider:

The members who didn’t renew the membership:

Category Preference SK hospital Others Total

Number of those not

Perception about the hospital:

Reasons for buying an insurance policy:

Source of information about the scheme:

Number for whom the entire family was 12

Perception about the scheme:

For those non-renewing members who availed of the services:

Number of those who availed the benefits: 7

Number of those who visited before becoming

Suggestions for improving the scheme:

Those members who got the membership renewed:

Preference of health-service providers:

Perception about the hospital:

Reasons for buying insurance:

Sources of information about KRUPA:

Number for whom the entire family was insured: