Role of insurance in determining utilization of healthcare and financial risk protection in India

Abstract

BackgroundUniversal health coverage has become a policy goal in most developing economies. We assess the association of health insurance (HI) schemes in general, and RSBY (National Health Insurance Scheme) in particular, on extent and pattern of healthcare utilization. Secondly, we assess the relationship of HI and RSBY on out-of-pocket (OOP) expenditures and financial risk protection (FRP).MethodsA cross-sectional study was undertaken to interview 62335 individuals among 12,134 households in 8 districts of three states in India i.e. Gujarat, Haryana and Uttar Pradesh (UP). Data on socio-demographic characteristics, assets, education, occupation, consumption expenditure, illness in last 15 days or hospitalization during last 365 days, treatment sought and its OOP expenditure was collected. We computed catastrophic health expenditures (CHE) as indicator for FRP. Hospitalization rate, choice of care provider and CHE were regressed to assess their association with insurance status and type of insurance scheme, after adjusting for other covariates.ResultsMean OOP expenditures for outpatient care among insured and uninsured were INR 961 (USD 16) and INR 840 (USD 14); and INR 32573 (USD 543) and INR 24788 (USD 413) for an episode of hospitalization respectively. The prevalence of CHE for hospitalization was 28% and 26% among the insured and uninsured population respectively. No significant association was observed in multivariate analysis between hospitalization rate, choice of care provider or CHE with insurance status or RSBY in particular.ConclusionHealth insurance in its present form does not seem to provide requisite improvement in access to care or financial risk protection.

Performance of India’s national publicly funded health insurance scheme, Pradhan Mantri Jan Arogaya Yojana (PMJAY), in improving access and financial protection for hospital care: findings from household surveys in Chhattisgarh state

“…The current study found that coverage under PMJAY or other PFHI schemes in Chhattisgarh did not reduce OOPE or CHE. The inability of PFHI in ensuring financial protection for hospital-care is consistent with many other studies of RSBY and other state-level PFHI schemes in India [15][16][17][18][19][20][21][22][23][24][25][26]. Some studies had suggested that the vertical cover of INR 30,000 (USD 420) annual sum assured per family might be insufficient, thereby causing possibility of CHE under RSBY [15,19].…”

“…The current study uses the data from Survey Rounds on Morbidity and Healthcare, which were carried out in 2004 and 2014 (Round 60th and 71st) respectively. The above datasets have been widely used in peer-reviewed research on healthcare in India, including on government health insurance schemes [18][19][20]26]. The 60th and 71st rounds are similar in design, content and coverage, and thereby provide comparable results [41].…”

“…It has also attracted a vigorous international debate on its merits and suitability for Indian health system [6][7][8][9][10][11][12][13]. The experience of RSBY in India has been well documented and its effectiveness in financial protection was found to be poor [14][15][16][17][18][19][20][21][22][23][24]. The evidence on impact of RSBY in improving access to hospital care has been mixed [15][16][17][18][19][20].…”

“…The experience of RSBY in India has been well documented and its effectiveness in financial protection was found to be poor [14][15][16][17][18][19][20][21][22][23][24]. The evidence on impact of RSBY in improving access to hospital care has been mixed [15][16][17][18][19][20]. Some states in India have implemented their own PFHI schemes with cover around 7 times bigger than RSBY [1,25,26].…”

Financial Insurance for Enterprises – Analysis of Demand and Supply

“…investment loans (Cummins, Dionne, Gagné, et al 2009;Wicka, 2016;Ganc 2018;Lane, 2019;Wicka & Parlińska, 2019;Franzoni & Pelizzari, 2019). The reason for the relatively low interest in financial insurance may be that it does not always have a significant impact on the company's financial situation (Prinja, Bahuguna, Gupta, Chowdhury & Trivedi, 2019). Also, the awareness of potential insurance buyers in various countries is often insufficient.…”