Acceptability of, and willingness to pay for, community health insurance in rural India

Objectives: To understand the acceptability of, and willingness to pay for, community health insurance coverage among residents of rural India. Methods: We conducted a mixed methods study of 33 respondents located in 8 villages in southern India. Interview domains focused on health-seeking behaviors of the family for primary healthcare, household expenditures on primary healthcare, interest in pre-paid health insurance, and willingness to pay for such a product. Results: Most respondents reported that they would seek care only when symptoms were manifest; only 6 respondents recognized the importance of preventative services. None reported impoverishment due to health expenditures. Few viewed health insurance as necessary either because they did not wish to be early adopters, because they had alternate sources of financial support, or because of concerns with the design of insurance coverage or the provider. Those who were interested reported being willing to pay Rs. 1500 ($27) as the modal annual insurance premium. Conclusions: Penetration of community health insurance programs in rural India will require education of the consumer base, careful attention to premium rate setting, and deeper understanding of social networks that may act as financial substitutes for health insurance.