perspective Impact of CBHI Schemes on Access to Healthcare: Evidence from India 1 K.S. James, Seeta Prabhu, Rajeev Ahuja and Alka Narang* The health system in India is inaccessible to a majority of the poor, who are ironically known to be more susceptible to disease. While the direct public provision of healthcare services has not been successful, alternate means of healthcare financing like user-fee have also largely been failures. In this context, community-based health insurance is being recognized as an important financing tool for improving access to health services for the poor. Indeed, several community- based health insurance (CBHI) initiatives have come up in different parts of rural and semi-rural India. The United Nations Development Programme (UNDP), with the help of other agencies, has initiated three CBHI schemes in three different regions in India. Differences in their design and implementation offer an interesting case for studying their impact. The objective of this study is to assess whether members of UNDP-sponsored CBHI schemes have had better access to healthcare. Based on a survey of 600 households, the authors carry out (logistic) regression analysis, to find out the impact that the CBHI schemes have had on improving the access of the target population to health services in the three pilot regions. The authors find that the scheme has positively improved the access of members to healthcare services. The authors use several control variables to arrive at this conclusion. INTRODUCTION Community-based health insurance is increasingly being viewed as an important fnancing tool for providing health services to the poor. This is partly because the state that assumed the function of providing free health services to the poor has not been successful in the past. Shrinking budgetary support for healthcare services, ineffciency in public health provision, unacceptably low quality of public health services, and the resultant imposition of user charges have heightened the concern for the poor, and led to the search for an alternate fnancing mechanism. Moreover, the belief that the poor are too poor to be able to save and contribute towards meeting their healthcare costs has been questioned in the recent past. There is now a growing realization that even the poor can make small, periodic contributions that can go towards meeting their healthcare needs (Zeller and Sharma, 1998). Hence, health insurance, even for low-income people, is increasingly being considered as an important fnancing tool in providing them access to health services. Indian Journal of Human Development, Vol. 2, No. 2, 2008 * K.S. James is with the Institute for Social and Economic Change, Bangalore; Seeta Prabhu is with UNDP, New Delhi; Rajeev Ahuja and Alka Narang are with World Bank, New Delhi.