In this month’s Bulletin

Where a system of national risk-pooling is not available, community-based health insurance can provide effective protection against being ruined by unexpected health care costs. The Medical Insurance Fund of the Self Employed Women’s Association in Gujarat was able to reimburse 1712 out of 1927 claims over a six-year period, 47% of them in full, and 53% in part (at a mean reimbursement rate of 55.6%). Reimbursement more than halved the percentage of catastrophic hospitalizations, i.e. those costing more than 10% of the annual household income and resulting in impoverishment. The scheme was set up in 1992 by women without a regular income. The annual premium for life insurance, medical insurance and asset insurance is 72.5 rupees (US$ 1.67), of which 30 rupees are earmarked for medical insurance. This provides maximum coverage of 1200 rupees (US$ 28). (See also Editorial, p. 612.)