Assessment of Family Planning Insurance Scheme (FPIS) with NHSRC

Sama was invited by the National Health Systems Resource Centre (NHSRC) to carry out an assessment of the FPIS scheme in six states – Assam, Haryana, Madhya Pradesh, Maharashtra, Rajasthan and Uttar Pradesh.

This assessment study was initiated by the Ministry of Health and Family Welfare (MoHFW) and implemented by the NHSRC with the following objectives:

  • To document the total number of claimants for compensation (including male sterilisation failures vis-a-vis total reported failures) and the number where claims were settled,   those not allowed and those pending & reasons thereof.
  • To review actual situation in implementation of the various processes and institutional structures specified under this scheme- that are meant to ensure that every potential claimant is correctly and promptly identified and that compensation is paid in good time.
  • To review the adherence to protocols and quality improvement measures in place to ensure that claims are reduced- due to lesser complications, failures and deaths.
  • To identify Constraints blocking or facilitating the proper implementation of the scheme in all its aspects and recommendations to improve further the performance of the scheme. This will also include analysis of reasons for increasing trend in Insurer’s liability, is it because of better reporting or awareness among the people regarding the FPIS or can it be attributed to quality of service/personnel/ infrastructure available at health facilities?

Sama was involved in the first phase of the study, carried out during November – December 2011, with NHSRC. This phase of the study involved gathering and preliminary analysis of secondary data and interviews with key informants from the centre and states.

At the State Level: Visits to the six states and meetings with State FPIS Nodal Officer or alternative respondents from the state ministries, State Insurance Coordinator to gather state level information about the processes, systems, and data on claims, claimants, etc.

At the Centre: Discussions with representatives of the Ministry of Health and Family Welfare (MoHFW) and the insurance company (ICICI Lombard).

Secondary data analysis: Based on the data received from the Ministry for the six states, and some information collected from the states, an analysis was done on death claims in districts, facilities and doctors in each of the states. This helped to identify any emerging patterns that could facilitate sampling for Phase II to be carried out by NHSRC with other partners. A detailed report based on the emerging trends and some recommendations based on this was submitted to NHSRC.

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