Clinical trial NCT00421629: Experimental Study to Assess Interventions Aimed at Improving the Equity Impact of Community-Based Health Insurance
Official title: Experimental Study to Assess Interventions Aimed at Improving the Equity Impact of Community-Based Health Insurance
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Health Insurance
Keywords: health insurance
hospitalization insurance
community based health insurance
health care access
developing countries
randomized controlled trials
Lead sponsor: London School of Hygiene and Tropical Medicine
Sponsor class: OTHER
Collaborators: name: Wellcome Trust
First posted: 2007-01-12
Enrollment: 688
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Allocation: RANDOMIZED
Intervention model: FACTORIAL
Primary purpose: HEALTH_SERVICES_RESEARCH

Brief summary: The purpose of this study is to assesses interventions aimed at improving the distributional impact of a community based health insurance scheme in rural India.

Detailed description: 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.

Comparisons: Three groups are compared to standard insurance scheme members (Control). One group is provided with after-sale service and supportive supervision (AfterSS). A second group is provided with prospective reimbursement (PR). A third group is provided with these two interventions together (Both).

Eligibility criteria: Subdistrict Inclusion Criteria:

* 500 or more female (\>=18 y of age) SEWA Insurance members in 2003

Subdistrict Exclusion Criteria:

* All members were mandatorily enrolled in the scheme by a donor agency
* Ahe sub-district had no general hospital of 25 beds or more

Individual Inclusion Criteria:

* All female and male members of SEWA Insurance for 2004 and 2005

Individual Exclusion Criteria:

* Those whose home could not be found based on given address data

Primary outcomes:
measure: socioeconomic status of claimants relative to the membership base in their subdistricts of residence
Secondary outcomes:
measure: enrolment rates in Vimo SEWA
measure: mean socioeconomic of the insured relative to the general rural population
measure: rate of insurance claim submission
Other outcomes:
Locations:
city: Ahmedabad
country: India
facility: Self Employed Women's Association
state: Gujarat
Study officials:
affiliation: London School of Hygiene and Tropical Medicine
name: Anne J Mills, MA DHSA PhD
role: PRINCIPAL_INVESTIGATOR
affiliation: London School of Hygiene and Tropical Medicine
name: Michael K Ranson, MD MPH PHD
role: STUDY_DIRECTOR
References:
citation: 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 Feb;62(3):707-20. doi: 10.1016/j.socscimed.2005.06.037. Epub 2005 Jul 28.
citation: 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 Mar;21(2):132-42. doi: 10.1093/heapol/czj010. Epub 2005 Dec 22.
citation: 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. 2006 Jan-Feb;97(1):72-5. doi: 10.1007/BF03405220.
citation: 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 Jul;28(4):382-90. doi: 10.1016/j.cct.2006.10.008. Epub 2006 Oct 14.
citation: 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. 2006 Sep-Oct;19(5):274-82.