India recently began a bold experiment in the delivery of healthcare that, if successful, will bring medicine and treatment to 500 million poor and near-poor Indians. To put that in perspective, when the US—a country of about 320 million—rolled out its Affordable Care Act (ACA) in 2010, the goal was to extend healthcare to nearly 50 million. Despite its many successes, the ACA experienced a number of difficulties, especially during roll-out, and some of those issues lingered for years.

For India, the sheer scale of its programme magnifies its many challenges, including how to communicate the benefits of the plan, and how to encourage enrolment. The success of the National Health Protection Scheme (NHPS)—known as Modicare, after Prime Minister Narendra Modi—depends crucially on whether people sign up for the service, whether they use it, and whether hospitals participate.

The challenge is daunting, but it is not insurmountable. Indeed, we have evidence to suggest methods that will encourage enrolment and help ensure a successful roll-out. We are part of a research team that recently completed a large-scale study of health insurance in Karnataka, where we encountered the very issues that confront Modicare. The results are promising.

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