International Journal of Health Care Quality Assurance

Purpose – Changing healthcare provision need not be sudden or damaging. If changes are made then many valuable services may be lost. This article aims to consider dramatic change and its negative effects on Indian rural healthcare provision.

Design/methodology/approach – A case study is used to evaluate rural India's developing private health insurance, combined with evidence from other micro health insurance effectiveness studies.

Findings – Rural health insurance schemes are financially and culturally precarious. Enthusiastically importing these ventures into rural scenarios fragments vulnerable healthcare systems that have served and survived many other threats. The new services may fail if not subsidised and the experiment might undermine what was already in place. Is it improvement or just change?

Research limitations/implications – Missing rural health providers from the dataset means that data are not regularly available.

Practical implications – As more Western healthcare concepts are parachuted into developing areas, understanding and appreciating what already exists is necessary. New healthcare schemes must be critically evaluated, including the damage they could do to other healthcare provision.

Originality/value – Unlike other published research on private health insurance introduced in India and Africa, this study critically reviews the effect in rural areas from vital hospital services' perspective.