Overview of publicly funded health insurance: Tamil Nadu model

Selvavinayagam, TS; Vijayakumar, Subash

doi:10.4103/0970-0218.99931

Cited by 4 publications

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“…In the same period, the claims ratio, or the amount paid in claims against the total premium amounted to the average of only 65% and in 45% of insurance cases reimbursed health expenditure did not exceed 20 GEL (less than 5% of total household consumption) [ 40 ]. Yet, this relatively low claims ratio, though not unusual [ 41 ], may have been caused by delays – possibly intentional – in enrolment of the eligible beneficiaries and aggressive utilisation management by some of the participating PICs and poorly informed beneficiaries [ 40 ]. Following this logic, curtailment of these adverse practices and the increased beneficiary awareness may have contributed to a significant increase in the claims ratio in subsequent years, reaching 98% in 2012 [ 42 ].…”

Section: Discussionmentioning

confidence: 99%

Promoting universal financial protection: health insurance for the poor in Georgia – a case study

Zoidze

Rukhazde

Chkhatarashvili

et al. 2013

Health Res Policy Sys

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BackgroundThe present study focuses on the program “Medical Insurance for the Poor (MIP)” in Georgia. Under this program, the government purchased coverage from private insurance companies for vulnerable households identified through a means testing system, targeting up to 23% of the total population. The benefit package included outpatient and inpatient services with no co-payments, but had only limited outpatient drug benefits. This paper presents the results of the study on the impact of MIP on access to health services and financial protection of the MIP-targeted and general population.MethodsWith a holistic case study design, the study employed a range of quantitative and qualitative methods. The methods included document review and secondary analysis of the data obtained through the nationwide household health expenditure and utilisation surveys 2007–2010 using the difference-in-differences method.ResultsThe study findings showed that MIP had a positive impact in terms of reduced expenditure for inpatient services and total household health care costs, and there was a higher probability of receiving free outpatient benefits among the MIP-insured. However, MIP insurance had almost no effect on health services utilisation and the households’ expenditure on outpatient drugs, including for those with MIP insurance, due to limited drug benefits in the package and a low claims ratio. In summary, the extended MIP coverage and increased financial access provided by the program, most likely due to the exclusion of outpatient drug coverage from the benefit package and possibly due to improper utilisation management by private insurance companies, were not able to reverse adverse effects of economic slow-down and escalating health expenditure. MIP has only cushioned the negative impact for the poorest by decreasing the poor/rich gradient in the rates of catastrophic health expenditure.ConclusionsThe recent governmental decision on major expansion of MIP coverage and inclusion of additional drug benefit will most likely significantly enhance the overall MIP impact and its potential as a viable policy instrument for achieving universal coverage. The Georgian experience presented in this paper may be useful for other low- and middle-income countries that are contemplating ways to ensure universal coverage for their populations.

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Section: Discussionmentioning

confidence: 99%

Promoting universal financial protection: health insurance for the poor in Georgia – a case study

Zoidze

Rukhazde

Chkhatarashvili

et al. 2013

Health Res Policy Sys

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“…The insurance scheme covered roughly 13.4 million families or 36 million individuals (Forgia & Nagpal, 2012). The eligibility requirement included those who were BPL, families that had an annual income of <₹72,000 INR (roughly 955 USD), or families of members of 26 welfare boards (informal sector workers; Forgia & Nagpal, 2012; Selvavinayagam & Vijayakumar, 2012).…”

Section: Introductionmentioning

confidence: 99%

Assessing the implementation of India's new health reform program, Ayushman Bharat, in two Southern states: Kerala and Tamil Nadu

Pillai¹

2022

World Med & Health Policy

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India's health indicators are negatively impacted by the high percentage of out‐of‐pocket expenditures, which leaves many unable to access health care or impoverishes them. To improve this situation, the Indian government in 2018, as part of health a reform program called Ayushman Bharat Initiative (AB), started the Pradhan Mantri Jan Arogya Yojana (PMJAY) as a scheme to provide financial access to secondary and tertiary healthcare services for people living in poverty. The AB‐PMJAY is a publicly‐funded insurance program that provides over $6,000 per indigent family per year for in‐patient hospital care. We compare the rollout of the program in two Indian States, Kerala and Tamil Nadu, which have relatively better health indicators compared with other Indian States. Questionnaires were developed for the two states based on the separate programs they had ongoing before AB‐PMJAY was introduced and the differing implementation strategy they undertook. We interviewed 21 health workers (10 from Kerala and 11 from Tamil Nadu), at the frontline of implementation and analyzed the narrative of the answers given for related themes. We found that low reimbursement rates may limit the number of private hospitals participating in the program, and that the classification criteria for eligibility may need to be updated. We also found that differing political alignment between the central government and subregional governments may affect how well the program is implemented. Overall, interview subjects felt that the program would lead to better health care access for the poor if well implemented and sustained.

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Who Benefits from India’s Publicly Funded Health Insurance Schemes? Unraveling Intersecting Gender and Socioeconomic Inequalities

Philip,

Iyer

2024

Handbook on Sex, Gender and Health

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Overview of publicly funded health insurance: Tamil Nadu model

Cited by 4 publications

References 0 publications

Promoting universal financial protection: health insurance for the poor in Georgia – a case study

Promoting universal financial protection: health insurance for the poor in Georgia – a case study

Assessing the implementation of India's new health reform program, Ayushman Bharat, in two Southern states: Kerala and Tamil Nadu

Who Benefits from India’s Publicly Funded Health Insurance Schemes? Unraveling Intersecting Gender and Socioeconomic Inequalities

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