Transformative Social Protection in Health in India Empowering poor patients to claim quality health care through community health insurance

With one of the largest conditional cash transfers programmes globally aiming to promote institutional deliveries among below poverty line (BPL) women; its internationally-lauded national health insurance scheme for BPL families and the announcement of a new health cess in the coming Five Year Programme (2012-2017), India is seemingly becoming top of the social protection in health (SPH) class. Since an average of 45 millions Indians become impoverished annually due to catastrophic health expenditures, the construction of a universal social protection in health policy more than necessarily. However, can health insurance programmes improve the access to quality and respectful health care for socially vulnerable Indians? In his doctoral research Joris Michielsen tries to answer this question.;According to the government the national health insurance scheme for BPL families can raise the purchasing power of poor making them equivalent partners on the health care market. Following the free market principles, they then can choose for the most qualitative provider and subsequently both public and private providers will improve their services in order to attract the poor patients of competitors. However, by means of a comparison of community health insurance schemes Joris Michielsen shows that removing financial barriers only offers a partial solution. Good quality care is not available everywhere. Hence, socially vulnerable patients often can't choose for a better competitor! Furthermore the research makes clear that the discrimination, brutal treatment, poor communication and financial exploitation that the poor experience when during medical consultations result from the social inequities in the broader Indian society. Only the community health insurance schemes which offer also social care and empowerment programmes next to the health insurance seem to improve the quality of the health care for the socially vulnerable.