This paper assesses the impact of the Self-Employed Women's Association's (SEWA's) Medical Insurance Fund, Gujarat, in terms of inclusion of the poor, hospital utilization, and expenditure. Age-matched insured and uninsured women were compared using survey data (2000). The authors found that wealth was not a determinant of membership in the Fund
i.e., the poor were not excluded. Of 28 hospitalizations among Fund members over one year, only five were reimbursed. Membership in SEWA was not significantly associated with increased frequency of hospitalization, but there was a significant association with lower costs of hospitalization, net of reimbursement. Unlike many other CBHI schemes, the Fund has overcome barriers that exclude the poorest. This is due in part to nesting of the Fund within a larger development organization. Utilization of the Fund, and thus impact on hospital utilization and expenditure, was minimal. This may relate to a lack of awareness of benefits among Fund members, or costs and difficulties associated with submitting an insurance claim.