And the last model is the linked model where the NGO collects the premium and passes it on to insurance companies like the New India Insurance or the National Insurance Company. Patients go to private providers usually and get care. Unfortunately, here it is not a cashless system so they have to pay the provider at the time of illness. The patient then submits the bills to the insurance company via the NGO and receives the reimbursement (usually after a lag period of 1- 3 months). Advantage of this is that the risk is taken by the insurance company and not by the NGO, so even small groups like 5000 people can get insured in this sort of model.

There are currently more than 20 CHIs all over the country of which the biggest one is in Karnataka. The average premium collected is about Rs 20 per person per year and ranges from Rs. 20 to Rs. 100. This is what the poor can afford, not the Rs. 356 as announced by the Prime Minister of India under the Universal Health Insurance Programme 2003. Usually the health care providers are NGOs or private providers. Unfortunately the Government has not been involved too much in these schemes. Usually the benefit package includes hospitalisation cover and the maximum limits range from Rs. 1200 to Rs. 1 lakh (average is about Rs 5000). The admission rates range from about 6-10 admissions per 1000 insured, which is higher than the national average for the poorest quintile of the population. Administrative costs are low because usually the community and the NGO subsidise the administrative costs.

These CHIs have been effective in enrolling large numbers of members and in increasing access to health care for these members. However, while in Africa there is evidence to show that CHIs are effective in protecting the members from catastrophic health expenditure, this is not yet clear in India. Also many of these CHIs depend on external resources to finance the scheme. This implies that there is a need for explicit subsidies to make it work.

Conclusion
To conclude, the poorer sections of the community can become further impoverished by health care costs. They need to be protected by various social or community health schemes.s