Skip to main content

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

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

  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%)
  1. @ 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.
  2. * Details of 2 episodes not available.