Sinha Tara, Ranson M Kent, Chatterjee Mirai, Acharya Akash, Mills Anne J
Research Coordinator, Vimo SEWA, SEWA Reception Centre, Opposite Victoria Garden, Bhadra, Ahmedabad 380 001, India.
Health Policy Plan. 2006 Mar;21(2):132-42. doi: 10.1093/heapol/czj010. Epub 2005 Dec 22.
This paper seeks to examine barriers faced by members of a community-based insurance (CBI) scheme, which is targeted at poor women and their families, in accessing scheme benefits. CBI schemes have been developed and promoted as mechanisms to offer protection to poor families from the risks of ill-health, death and loss of assets. However, having voluntarily enrolled in a CBI scheme, poor households may find it difficult or impossible to access scheme benefits. The paper describes the results of qualitative research carried out to assess the barriers faced in accessing scheme benefits by members of the CBI scheme run by the Self-Employed Women's Association (SEWA) in Gujarat, India. The study finds that the members face a variety of different barriers, particularly in seeking hospitalization and in submitting insurance claims. Some of the barriers are rooted in factors outside the scheme's control, such as illiteracy and financial poverty amongst members, and inadequacies of the transportation and health care infrastructure. But other barriers relate to the scheme's design and management, for example, lack of clarity among scheme staff regarding the scheme's rules and processes, and requirements that claimants submit documents to prove the validity of their claims. The paper makes recommendations as to how SEWA Insurance can address some of the identified barriers and discusses the relevance of these findings to other CBI schemes in India and elsewhere.
本文旨在研究一个针对贫困妇女及其家庭的社区保险（CBI）计划的成员在获取计划福利时所面临的障碍。CBI计划已被开发和推广，作为保护贫困家庭免受健康不佳、死亡和资产损失风险的机制。然而，贫困家庭在自愿加入CBI计划后，可能会发现难以或无法获得计划福利。本文描述了为评估印度古吉拉特邦自营职业妇女协会（SEWA）运营的CBI计划成员在获取计划福利时所面临的障碍而进行的定性研究结果。研究发现，成员们面临着各种不同的障碍，尤其是在寻求住院治疗和提交保险索赔方面。一些障碍源于计划无法控制的因素，例如成员中的文盲和经济贫困，以及交通和医疗基础设施的不足。但其他障碍与计划的设计和管理有关，例如，计划工作人员对计划规则和流程缺乏清晰认识，以及要求索赔人提交文件以证明其索赔的有效性。本文就SEWA保险如何解决一些已确定的障碍提出了建议，并讨论了这些研究结果与印度及其他地区其他CBI计划的相关性。
