Impact evaluation of India's ‘Yeshasvini’ community‐based health insurance programme

Using propensity score matching techniques, the study evaluates the impact of India's Yeshasvini community-based health insurance programme on health‐care utilisation, financial protection, treatment outcomes and economic well‐being. The programme offers free out‐patient diagnosis and lab tests at discounted rates when ill, but, more importantly, it covers highly catastrophic and less discretionary in‐patient surgical procedures. For its impact evaluation, 4109 randomly selected households in villages in rural Karnataka, an Indian state, were interviewed using a structured questionnaire. A comprehensive set of indicators was developed and the quality of matching was tested. Generally, the programme is found to have increased utilisation of health‐care services, reduced out‐of‐pocket spending, and ensured better health and economic outcomes. More specifically, however, these effects vary across socio‐economic groups and medical episodes. The programme operates by bringing the direct price of health‐care down but the extent to which this effectively occurs across medical episodes is an empirical issue. Further, the effects are more pronounced for the better‐off households. The article demonstrates that community insurance presents a workable model for providing high‐end services in resource‐poor settings through an emphasis on accountability and local management. Copyright (C) 2010 John Wiley & Sons, Ltd.