Determinants of enrolment and experiences of Rashtriya Swasthya Bima Yojana (RSBY) beneficiaries in Udupi district, India

Kamath, Ramachandra; Sanah, Noore; Machado, Leonard; Sekaran, Varalakshmi Chandra

doi:10.4103/2230-8598.127164

Cited by 9 publications

(4 citation statements)

References 5 publications

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“…14,15 However, only a limited number of studies in Asia have explored these factors at household level. 16,17 Given a unique socio-economic context, health system status and a unique family-based insurance modality of the NHIP, the factors established at those countries are likely to vary in the Nepalese context. Nonetheless, the evidence base for health insurance programs in Nepal remains very weak.…”

Section: Introductionmentioning

confidence: 99%

Factors Associated with Enrolment of Households in Nepal’s National Health Insurance Program

Ghimire

Sapkota

Poudyal

2019

Int J Health Policy Manag

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Background: Nepal has made remarkable efforts towards social health protection over the past several years. In 2016, the Government of Nepal introduced a National Health Insurance Program (NHIP) with an aim to ensure equitable and universal access to healthcare by all Nepalese citizens. Following the first year of operation, the scheme has covered 5 percent of its target population. There are wider concerns regarding the capacity of NHIP to achieve adequate population coverage and remain viable. In this context, this study aimed to identify the factors associated with enrolment of households in the NHIP.Methods: A cross-sectional household survey using face to face interview was carried out in 2 Palikas (municipalities) of Ilam district. 570 households were studied by recruiting equal number of NHIP enrolled and non-enrolled households. We used Pearson’s chi-square test and binary logistic regression to identify the factors associated with household’s enrolment in NHIP. All statistical analyses were performed using IBM SPSS version 23 software.Results: Enrolment of households in NHIP was found to be associated with ethnicity, socio-economic status, past experience of acute illness in family and presence of chronic illness. The households that belonged to higher socio-economic status were about 4 times more likely to enrol in the scheme. It was also observed that households from privileged ethnic groups such as Brahmin, Chhetri, Gurung, and Newar were 1.7 times more likely to enrol in NHIP compared to those from underprivileged ethnic groups such as janajatis (indigenous people) and dalits (the oppressed). The households with illness experience in 3 months preceding the survey were about 1.5 times more likely to enrol in NHIP compared to households that did not have such experience. Similarly, households in which at least one of the members was chronically ill were 1.8 times more likely to enrol compared to households with no chronic illness.Conclusion: Belonging to the privileged ethnic group, having a higher socio-economic status, experiencing an acute illness and presence of chronically ill member in the family are the factors associated with enrolment of households in NHIP. This study revealed gaps in enrolment between rich-poor households and privileged-underprivileged ethnic groups. Extension of health insurance coverage to poor and marginalized households is therefore needed to increase equity and accelerate the pace towards achieving universal health coverage.

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Section: Introductionmentioning

confidence: 99%

Factors Associated with Enrolment of Households in Nepal’s National Health Insurance Program

Ghimire

Sapkota

Poudyal

2019

Int J Health Policy Manag

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“…A study in Udupi district of Karnataka state has, for example, shown that the majority of RSBY subscribers have found the scheme beneficial and were willing to renew their enrolment (Kamath et al 2014). Studies also show that in the large majority of the states, monthly healthcare expenditure for inpatient treatment has either reduced or remained constant since the introduction of the scheme (Sinha and Chatterjee 2014).…”

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confidence: 99%

Health insurance in India: what do we know and why is ethnographic research needed

Ahlin

Nichter

Pillai

2016

Anthropology & Medicine

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The percentage of India's national budget allocated to the health sector remains one of the lowest in the world, and healthcare expenditures are largely out-of-pocket (OOP). Currently, efforts are being made to expand health insurance coverage as one means of addressing health disparity and reducing catastrophic health costs. In this review, we document reasons for rising interest in health insurance and summarize the country's history of insurance projects to date. We note that most of these projects focus on in-patient hospital costs, not the larger burden of out-patient costs. We briefly highlight some of the more popular forms that government, private, and community-based insurance schemes have taken and the results of quantitative research conducted to assess their reach and cost-effectiveness. We argue that ethnographic case studies could add much to existing health service and policy research, and provide a better understanding of the life cycle and impact of insurance programs on both insurance holders and healthcare providers. Drawing on preliminary fieldwork in South India and recognizing the need for a broad-based implementation science perspective (studying up, down and sideways), we identify six key topics demanding more in-depth research, among others: (1) public awareness and understanding of insurance; (2) misunderstanding of insurance and how this influences health care utilization; (3) differences in behavior patterns in cash and cashless insurance systems; (4) impact of insurance on quality of care and doctor-patient relations; (5) (mis)trust in health insurance schemes; and (6) health insurance coverage of chronic illnesses, rehabilitation and OOP expenses.

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“…The household head's characteristics [28] and the occupation of its members [27] are also known to be linked with the usage of the HI. More recent literature has confirmed the relevance of these variables in predicting the HI enrollment [8,10,13,29]. Among the states, we use Karnataka as the baseline, reference state.…”

Section: Explanatory Variablesmentioning

confidence: 99%

Wealth Status and Health Insurance Enrollment in India: An Empirical Analysis

2023

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Since 2005, health insurance (HI) coverage in India has significantly increased, largely because of the introduction of government-funded pro-poor insurance programs. As a result, the determinants of HI enrollment and their relative importance may have changed. Using National Family Health Survey (NFHS)-4 data, collected in 2015–2016, and employing a Probit regression model, we re-examine the determinants of household HI enrollment. Then, using a multinomial logistic regression model, we estimate the relative risk ratio for enrollment in different HI schemes. In comparison to the results on the determinants of HI enrollment using the NFHS data collected in 2005–2006, we find a decrease in the wealth gap in public HI enrollment. Nonetheless, disparities in enrollment remain, with some changes in those patterns. Households with low assets have lower enrollments in private and community-based health insurance (CBHI) programs. Households with a higher number of dependents have a higher likelihood of HI enrollment, especially in rural areas. In rural areas, poor Scheduled Caste and Scheduled Tribe households are more likely to be enrolled in public HI than the general Caste households. In urban areas, Muslim households have a lower likelihood of enrollment in any HI. The educational attainment of household heads is positively associated with enrollment in private HI, but it is negatively associated with enrollment in public HI. Since 2005–2006, while HI coverage has improved, disparities across social groups remain.

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Determinants of enrolment and experiences of Rashtriya Swasthya Bima Yojana (RSBY) beneficiaries in Udupi district, India

Cited by 9 publications

References 5 publications

Factors Associated with Enrolment of Households in Nepal’s National Health Insurance Program

Factors Associated with Enrolment of Households in Nepal’s National Health Insurance Program

Health insurance in India: what do we know and why is ethnographic research needed

Wealth Status and Health Insurance Enrollment in India: An Empirical Analysis

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