Plain English Summary
Background and study aims
This study aimed to identify ways of making the benefits of a health insurance scheme in Gujarat, India, more accessible to its poorest members. Normally, in order to be eligible for reimbursement under this insurance scheme, a member had to be hospitalized, had to pay for her hospitalization out-of-pocket, and then had to submit an insurance claim. Research we conducted in 2003 suggested that the poorest members of this insurance scheme were the least likely to benefit from it. Among the problems they faced were jobs and responsibilities that prevented them from seeking hospitalization, and difficulties paying for hospitalization. This study involves testing two different interventions intended to make health insurance benefits more accessible.
Who can participate?
All female and male members of SEWA insurance for 2004 and 2005.
What does the study involve?
One intervention involves paying the insurance benefits upfront when the woman was admitted to hospital, rather than by reimbursement. The second intervention involves strengthening contacts between members and administrators, to make the process of submitting a claim easier and less expensive. Participants are randomly allocated to either the first intervention, the second intervention, or the two interventions together.
What are the possible benefits and risks of participating?
Not provided at time of registration
Where is the study run from?
London School of Hygiene and Tropical Medicine (UK)
When is the study starting and how long is it expected to run for?
October 2003 to April 2006
Who is funding the study?
Wellcome Trust (UK)
Who is the main contact?
Prof Anne Mills
anne.mills@lshtm.ac.uk
Trial website
Contact information
Type
Scientific
Primary contact
Prof Anne J Mills
ORCID ID
http://orcid.org/0000-0001-9863-9950
Contact details
London School of Hygiene and Tropical Medicine
Keppel Street
London
WC1E 7HT
United Kingdom
-
anne.mills@lshtm.ac.uk
Additional identifiers
EudraCT number
ClinicalTrials.gov number
NCT00421629
Protocol/serial number
067926; PHHPBD25
Study information
Scientific title
Experimental study to assess interventions aimed at improving the equity impact of community-based health insurance
Acronym
Study hypothesis
Community based health insurance is often cited as a means of improving access and financial protection in developing countries, but such schemes may not benefit the poorest. We evaluate alternative strategies for improving the uptake of benefits of a community based health insurance scheme by its poorest members.
The purpose of this study is to assess interventions aimed at improving the distributional impact of a community based health insurance scheme in rural India.
Ethics approval
Received from the local medical ethics committee on 15/03/2003, ref: 948
Study design
Health services research, randomised, open label, active control, factorial assignment
Primary study design
Interventional
Secondary study design
Randomised controlled trial
Trial setting
Other
Trial type
Quality of life
Patient information sheet
Condition
Health insurance
Intervention
Three groups are compared to standard insurance scheme members (control):
1. Group one is provided with After-Sale Service and supportive supervision (AfterSS)
2. Group two is provided with Prospective Reimbursement (PR)
3. Group three is provided with these two interventions together (both)
Intervention type
Other
Phase
Not Applicable
Drug names
Primary outcome measure
Socioeconomic status of claimants relative to the membership base in their subdistricts of residence.
Secondary outcome measures
1. Enrolment rates in Vimo SEWA
2. Mean socioeconomic of the insured relative to the general rural population
3. Rate of insurance claim submission
Overall trial start date
01/10/2003
Overall trial end date
01/04/2006
Reason abandoned (if study stopped)
Eligibility
Participant inclusion criteria
Subdistrict inclusion criteria:
500 or more female (greater than or equal to 18 years of age) Self Employed Womens Association (SEWA) insurance members in 2003.
Individual inclusion criteria:
All female and male members of SEWA insurance for 2004 and 2005.
Participant type
Patient
Age group
Adult
Gender
Female
Target number of participants
688
Participant exclusion criteria
Subdistrict exclusion criteria:
1. All members were mandatorily enrolled in the scheme by a donor agency
2. The sub-district had no general hospital of 25 beds or more
Individual exclusion criteria:
Those whose home could not be found based on given address data.
Recruitment start date
01/10/2003
Recruitment end date
01/04/2006
Locations
Countries of recruitment
India
Trial participating centre
London School of Hygiene and Tropical Medicine
London
WC1E 7HT
United Kingdom
Trial participating centre
Self Employed Women's Association
SEWA Reception Centre
Opp. Victoria Garden
Bhadra
Ahmedabad
380 001
India
Sponsor information
Organisation
London School of Hygiene and Tropical Medicine (UK)
Sponsor details
Keppel Street
London
WC1E 7HT
United Kingdom
-
anne.mills@lshtm.ac.uk
Sponsor type
Hospital/treatment centre
Website
Funders
Funder type
Charity
Funder name
Wellcome Trust (UK) (grant ref: 067926)
Alternative name(s)
Wellcome
Funding Body Type
private sector organisation
Funding Body Subtype
international
Location
United Kingdom
Results and Publications
Publication and dissemination plan
Not provided at time of registration
Intention to publish date
Participant level data
Available on request
Basic results (scientific)
Publication list
Results in:
1. 2006 results in http://www.ncbi.nlm.nih.gov/pubmed/16054740
2. 2006 barriers to trial results: http://www.ncbi.nlm.nih.gov/pubmed/16373360
3. 2006 challenges to trial results: http://www.ncbi.nlm.nih.gov/pubmed/16512334
4. 2006 preferred provider system results: http://www.ncbi.nlm.nih.gov/pubmed/17203684
5. 2007 measuring improved targeting results: http://www.ncbi.nlm.nih.gov/pubmed/17126613
6. 2007 equitable utilisation results: http://www.ncbi.nlm.nih.gov/pubmed/17526594
7. 2007 management initiatives results: http://www.ncbi.nlm.nih.gov/pubmed/17708589
Publication citations
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Results
Ranson MK, Sinha T, Chatterjee M, Acharya A, Bhavsar A, Morris SS, Mills AJ, Making health insurance work for the poor: learning from the Self-Employed Women's Association's (SEWA) community-based health insurance scheme in India., Soc Sci Med, 2006, 62, 3, 707-720, doi: 10.1016/j.socscimed.2005.06.037.
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Barriers to trial results
Sinha T, Ranson MK, Chatterjee M, Acharya A, Mills AJ, Barriers to accessing benefits in a community-based insurance scheme: lessons learnt from SEWA Insurance, Gujarat., Health Policy Plan, 2006, 21, 2, 132-142, doi: 10.1093/heapol/czj010.
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Challenges to trial results
Ranson MK, Sinha T, Morris SS, Mills AJ, CRTs--cluster randomized trials or "courting real troubles": challenges of running a CRT in rural Gujarat, India., Can J Public Health, 97, 1, 72-75.
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Preferred provider system results
Ranson MK, Sinha T, Gandhi F, Jayswal R, Mills AJ, Helping members of a community-based health insurance scheme access quality inpatient care through development of a preferred provider system in rural Gujarat., Natl Med J India, 19, 5, 274-282.
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Measuring improved targeting results
Morris SS, Ranson MK, Sinha T, Mills AJ, Measuring improved targeting of health interventions to the poor in the context of a community-randomised trial in rural India., Contemp Clin Trials, 2007, 28, 4, 382-390, doi: 10.1016/j.cct.2006.10.008.
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Equitable utilisation results
Ranson MK, Sinha T, Chatterjee M, Gandhi F, Jayswal R, Patel F, Morris SS, Mills AJ, Equitable utilisation of Indian community based health insurance scheme among its rural membership: cluster randomised controlled trial., BMJ, 2007, 334, 7607, 1309, doi: 10.1136/bmj.39192.719583.AE.
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Management initiatives results
Sinha T, Ranson MK, Chatterjee M, Mills A, Management initiatives in a community-based health insurance scheme., Int J Health Plann Manage, 22, 4, 289-300, doi: 10.1002/hpm.898.