Community-based Health Insurance Systems

Community based health insurance systems may be broadly defined as non-profit prepayment plans for healthcare controlled by a community that has voluntary membership. The systems operate according to core social values and cover beneficiaries excluded from other health coverage. There is evidence that such schemes reduce out-of-pocket spending. They may also fill gaps in the existing schemes (such as providing healthcare for informal sector workers) enabling a more universal coverage.

However, the sustainability of most community-based health insurance schemes are questionable as they are often unable to raise enough resources because of the limited income of the community. The schemes’ size and resource levels, limited management skills available with the community, limited potential to negotiate with providers for quality and price, inability to cover the poorer sections of the population, etc. are some of the weaknesses of the system. While government intervention can help in improving the efficiency and sustainability of such systems, they can only be regarded as complementary systems to other forms of healthcare financing arrangements.