Indian community health insurance schemes provide partial protection against catastrophic health expenditure

Table 2 Details of claims in two CHI schemes in India (01/04/2003 to 31/03/2004)

	ACCORD	SEWA
Type of provider
Total claims	683	3152
in government hospitals	-	238 (8%)
in NGO hospitals	683 (100%)	204 (6%)
in private-for-profit hospitals	-	2710 (86%)
Details of claims made
Median claim amount (95% CI) in US$	11.8 (10.9, 12.7)	46.4 (45.2, 47.5)
Median claim honoured (95% CI)^@ in US$	10.4 (9.5, 11.2)	12.9 (12.7, 13.1)
Number of claims that were honoured (%)	643 (94%)	2543 (81%)
Number of claims that were fully honoured (%)	507 (79%)	1206 (47%)
Number of claims that were partially honoured (%)	136 (21%)	1337 (53%)
Median delay (Q1, Q3) between discharge and reimbursement in days	-	49 (23, 81)
Type of illnesses
Acute illnesses	401 (59%)*	2346 (74%)
Pre-existing illnesses	280 (41%)	806 (26%)

^@ The term "honoured" has different implications in the two schemes. At SEWA it means "reimbursement" while at ACCORD, it implies the amount paid through direct third party payment.
* Details of 2 episodes not available.

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