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.

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).

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