Impact of Publicly Financed Health Insurance Schemes on Healthcare Utilization and Financial Risk Protection in India: A Systematic Review

Abstract

Several publicly financed health insurance schemes have been launched in India with the aim of providing universalizing health coverage (UHC). In this paper, we report the impact of publicly financed health insurance schemes on health service utilization, out-of-pocket (OOP) expenditure, financial risk protection and health status. Empirical research studies focussing on the impact or evaluation of publicly financed health insurance schemes in India were searched on PubMed, Google scholar, Ovid, Scopus, Embase and relevant websites. The studies were selected based on two stage screening PRISMA guidelines in which two researchers independently assessed the suitability and quality of the studies. The studies included in the review were divided into two groups i.e., with and without a comparison group. To assess the impact on utilization, OOP expenditure and health indicators, only the studies with a comparison group were reviewed. Out of 1265 articles screened after initial search, 43 studies were found eligible and reviewed in full text, finally yielding 14 studies which had a comparator group in their evaluation design. All the studies (n-7) focussing on utilization showed a positive effect in terms of increase in the consumption of health services with introduction of health insurance. About 70% studies (n-5) studies with a strong design and assessing financial risk protection showed no impact in reduction of OOP expenditures, while remaining 30% of evaluations (n-2), which particularly evaluated state sponsored health insurance schemes, reported a decline in OOP expenditure among the enrolled households. One study which evaluated impact on health outcome showed reduction in mortality among enrolled as compared to non-enrolled households, from conditions covered by the insurance scheme. While utilization of healthcare did improve among those enrolled in the scheme, there is no clear evidence yet to suggest that these have resulted in reduced OOP expenditures or higher financial risk protection.

Strengthening health technology assessment systems in the global south: a comparative analysis of the HTA journeys of China, India and South Africa

“…As of 2014, less than 20% of the population were covered by government schemes with majority of the population utilising private health care providers. Out-of-Pocket Payments (OOPs) accounted for 62% of total health expenditure [48], leaving millions of the population at risk of falling into debt or poverty [46,49–52]. Government expenditure on healthcare has been low (1.04% of GDP in 2014) and the rise of non-communicable diseases has put further strain on the health sector [53–55].…”

Public, patient and carers’ views on palliative and end‐of‐life care in India

“…), there is evidence that such developments neither made a significant impact on out‐of‐pocket expenses nor provided any financial risk protection among Indians (Prinja et al. ). Reflecting this fact, our review studies indicate that the lack of basic life needs and financial constraints among Indian families seems to challenge the quality of care for their dying relatives and also the choice of preferred place of death (Elsner et al.…”

“…However, there remain significant economic and social inequalities (Bhagwati & Panagariya 2013). Despite, various government-led initiatives such as national health insurance and universal healthcare coverage schemes in India, such as Rashtriya Swasthya Bima Yojana (RSBY), the health insurance scheme for the poor, introduced in 2008 (Sood et al 2014), there is evidence that such developments neither made a significant impact on out-of-pocket expenses nor provided any financial risk protection among Indians (Prinja et al 2017). Reflecting this fact, our review studies indicate that the lack of basic life needs and financial constraints among Indian families seems to challenge the quality of care for their dying relatives and also the choice of preferred place of death (Elsner et al 2012;Kandasamy et al 2008;Khan Joad et al 2011).…”

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