Exploring Viability in Primary Care Insurance: A Study of CARE Hospital Foundation's Innovative Experiment in India

The case study evaluates the financial viability of CARE Foundation’s rural primary-health-care delivery model. CARE’s model envisioned providing primary health care in rural India by enabling access to affordable care at the doorstep. The case study also reviews the performance of the outpatient insurance product, an element of CARE’s model. The study was based on semi-structured interviews conducted in five villages, and also on secondary literature covering similar global and national experiences. It covers the following sections in detail:

• Background of the program with a focus on the challenges and its objectives;
• Impact evaluation of the program with a focus on the use of health-care by insured groups, impact on hospitalization expenses, and impact on the days of illness among members;
• Analysis of coverage ratio with a focus on the supply-side factors affecting coverage ratio and the demand side factors affecting penetration ratio;
• Analysis of the claims ratio and renewal ratio of the outpatient insurance product;
• Use of technology for the program and future scope;
• Review of the financial performance of the pilot program from 2009 to 2012;
• Recommendations for the program with a focus on improving profitability, expanding the program, and other recommendations applicable to the entire health care sector.