In developing countries, including India, the cost of healthcare is mainly paid out-ofpocket (OOP) at the point of service delivery. This fact persists despite the attempt to create publicly financed health centres as these health centres often do not provide proximate services, or indeed the expected level of quantity or quality of healthcare because of poor staffing, equipment or stock of medicines etc. (Dalal & Dawad 2009, GOI 2008, De Costa & Diwan 2007, Kotwani et al. 2007, NCMH 2005, Satpathy 2005, Kamat 1995). The OOP expenditures reach on average up to 50% of total health expenditures in low income countries; In India, more than 60% of total health expenditures is paid OOP (Figure 1.1) (World Bank 2012). Member States of the World Health Organization committed in 2005 to develop their health financing systems so that all people would have access to services and would not suffer financial hardship paying for them (World Health Assembly resolution 58.33). The preferred health financing policies to reduce OOP spending and achieve universal coverage have been risk pooling and health insurance mechanisms (James & Savedoff 2010, WHO 2010).

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F.F.H. Rutten (Frans)
Erasmus University Rotterdam
Erasmus School of Health Policy & Management (ESHPM)

Binnendijk, H. (2014, January 9). Designing Community-Based Health Insurance among Rural Poor in India: A novel time- and cost-effective method for data sourcing. Retrieved from http://hdl.handle.net/1765/50282