Implementing a Participatory Model of Micro Health Insurance Among Rural Poor with Evidence from Nepal

This paper reports on two voluntary, contributory, contextualized, community-based health insurance (CBHI) schemes, launched in Dhading and Banke (Nepal) in 2011. The implementation followed a four stage process: initiating (baseline survey), involving (awareness generation and engaging community in benefit-package-design), launch (enrollment and training of selected community members) and post launch (viable claims ratio; settled within satisfactory time, sustainable affiliation). Both schemes were successful on four key parameters: effective planning; affiliation (grew from 0 to about 10,000) and renewals (>65%); claims ratio (~50%); and promptness of claim settlement (~23 days). This model succeeded in implementing CBHI with zero premium subsidies or subsidized healthcare costs. The successful operation relied in large part on the fact that members trust that they can enforce this contract. Considerable insurance education and capacity development is necessary prior to launch of the CBHI, and for sustainable operations as well as for scaling