Effect of public-funded health insurances in financial protection for hospitalisation in Rajasthan state, India: Evidence from a national sample survey

Abstract

BackgroundThe high burden of out-of-pocket expenditure (OOPE) in India has led to introduction of several public-funded health insurance (PFHI) programmes. This study examined the impact of PFHI on hospitalisation-related OOPE in the Rajasthan state. MethodsData from the National Sample Survey 75th round on Social Consumption (Health), were utilized for this study. The sample of Rajasthan state, consisting of 5045 households and 28,020 individuals, was analysed to determine factors associated to PFHI coverage, choice of healthcare provider and OOPE. ResultsOne third of the population was covered by PFHI. In the private facility, although PFHI reduced OOPE (INR 17000 vs 14,700), it did not reduce catastrophic health expenditure (CHE), i.e., CHE 10% (47.1% vs 47.2%), CHE 25% (19.2 vs 23.4%). In government hospitals, PFHI reduced OOPE (INR 2500 vs. 2050), CHE 10% (11.1% vs 7.8%), and CHE 25% (3.6% vs. 2.7%). PFHI did not have any significant effect on the choice of healthcare provider in hospitalised patients in Rajasthan (AOR 0.95, P = 0.538). ConclusionThe study suggests that PFHI does not have any effect on OOPE associated with hospitalisation. Government-funded healthcare is more effective in providing financial protection compared to private healthcare with PFHI. Private facilities are still chosen despite lower OOPE in government facilities due to quality and availability concerns. These limitations of PFHIs must be thoroughly examined before switching from subsidised services to purchases from private facilities. A combination of both approaches should be integrated to achieve universal health care and financial protection for all.