外文原文：外文原文：Microinsurance: Innovation In Low-Health InsuranceDavidABSTRACT: Microinsurance low cost health insurance based on a community, cooperative, or mutual and self-help arrangements can provide financial protection for poor households and improve access to health care. However, low benefit caps and a low share of premiums paid as benefits both designed to keep these arrangements in business perversely limited these schemes ability to extend coverage, offer financial protection, and retain members. We studied three schemes in India, two of which are member operated and one a commercial scheme, using household surveys of insured and uninsured house-holds and interviews with managers. All three enrolled poor households and raised their use of hospital services, as intended. Financial exposure was greatest, and protection was least, in the commercial scheme, which imposed the lowest caps on benefits and where income was the lowest. Increasing awareness in India about the value of health insurance has led to a diversity of plans, including “microinsurance.” Microinsurance is low-cost health insurance based on a community or cooperative model, as distinct from conventional insurance. Microinsurance units can increase access to health care, improve equality among members, capture additional resources, and promote social protection and the development of financial systems. Most of them require reinsurance. Micro health insurance covered an estimated thirty-six million people worldwide in 2006. We report on a study of three microinsurance arrangements operating in two Indianstates. The three differ in target membership, benefits, and claims management practices. We identify the strengths and shortcomings of the different approaches as judged by their impact on financial protection and equitable access to expensive health care. Unlike commercial insurers, affiliation with a microinsurance scheme is voluntary but is often open only to people who are linked with the group in other ways (which limits their scope for increasing membership). Some operate as mutual schemes, with members being both insured and carriers of risk. This model can attenuate potential conflicts of interest between insurer and insured. Solidarity enhancing rules keep individual interests (which could increase adverse selection) restrained by group interests. We analyzed the microinsurance schemes operational results by how well each benefited its members.Description of The Three Microinsurance Units Bharatiya Agro Industries Foundation (BAIF). In 2002 the Development Research Foundation launched a commercial health insurance plan at its rural outpost in Pune, India, for women ages 1870 participating in so called self-help groups. The annual premium was INR 131.75 (US$3)13 (plus an administrative fee of INR 25, or US$0.50); the benefit covered hospitalization up to INR 5,000 (US$113.65), plus concessionary prices for primary care at a BAIF center. Facing a 75 percent premium increase in 2003, the members launched a mutual scheme. The premium remained unchanged, with benefits capped at INR 5,000 (or less if all claims in any month exceeded one-twelfth of the annual premium). Claims not fully settled are eligible for reimbursement in future months when balances are positive. This “relative benefit” plan ensures that the scheme never runs a deficit; the claims loss ratio (the share of premiums used to pay claims)was 92 percentin2005.A committee of members settles claims, monitors financial performance, and determines strategic direction. Membership grew when family members were added in 2004. By 2005, some 600 households had joined. Up Lift Health. Up Lift Health began health insurance operations in 2003 in Pune City among slum-dwelling adults who borrowed from Up Lift Indias microfinance mechanism .Membership in 2005was 16,356; premiums were age related, then (in 2004) standardized at INR 100 (US$2.27) per person per year, discounted to 50 percent if entire households joined. Up Lifts social workers collect premiums. Up Lifts microinsurance reimburses up to 80 percent of hospitalization costs, capped at INR 5,000 per person and year. Different maximum limits apply for specific illnesses. 14 Preexisting conditions and bills from out-of-net-work hospitals are excluded. Up Lift pays income-loss compensation of INR 50 (US$1) per day (for days 318 of hospitalization). It negotiates discounts for outpatient care, organizes checkup camps and monthly prevention talks, and operates a 24/7 telephone “health hotline” giving medical guidance. A members claim committee decides reimbursement; it can authorize humanitarian reimbursements (from a “solidarity fund”) for otherwise unqualified claims. The claims loss ratio was 42 percent in 2005.Nidan. Nidan targets market vendors in Patna, Bihar; it had 10,189 members in 2005. Nidans microinsurance unit was launched in 2001, through an association with the Self Employed Womens Association (SEWA)5, 1