Objectives of the Scheme
The objectives of the “Composite Tribal Health Insurance Package” are:
- To access health care with dignity by not depending on charity or handouts;
- To encourage health seeking behaviour by offering comprehensive health care with minimal payment at the time of use of the services
- To enhance the feeling of solidarity among the members of the AMS
- To protect the AMS members from catastrophic health expenditure
- To enhance the feeling of ownership of the health programme among the members of the AMS by contributing towards their own health care
- To provide a stable income for the adivasi hospital
Characteristics and Functioning of the Scheme
1. The target group are the adivasi communities living in the Gudalur taluk. Families from the community have to be members of the people’s organisation (AMS) to be able to join the health insurance scheme.
2. Once tribals have joined AMS (where membership is voluntary) they are automatically insured with the insurance company. However, those who pay an annual premium of Rs. 20 per person are entitled to universal health care. Those who do not pay this amount, can avail of health care from ASHWINI, but by paying a small user fee.
3. Joining AMS does necessitate participating in all the community-based activities of AMS – this bond of solidarity has to be demonstrable and reduces the likelihood of moral hazard. The risk of adverse selection is also countered by the system of automatic membership for all AMS members.
4. Free health care is provided to all AMS members but those who have not paid the premium that year, must pay nominal amount for outpatient and inpatient services.
There are three sub-categories of beneficiaries:
(1) Members of AMS who have paid their premium are entitled to free universal health coverage from the scheme;
(2) Members of the AMS who have not paid the annual premium can avail of the health benefits but have to pay a small co-payment; and
(3) Those who are not members of the AMS have to meet the cost of the medicines.
The difference between these groups is that tribals who have paid their premium have to pay less of the costs of their treatment.
