Effectiveness of Community Based Health Finance on Utilization of Health Care Services and Out of Pocket Expenditure among Women in Rural Pune Maharashtra

Abstract

The aim of the study was to assess effectiveness of a community based health insurance (CBHF) scheme on socio-demographic (household profile-characteristics of household enrolled) profile, utilization of health services as well as on financial protection of money against the catastrophic expenditure among insured and non-insured women. Financial barrier is one of the major bottlenecks for access and use of health care services. Since having health insurance cannot guarantee access to care among the insured persons, their actual health seeking behavior should be evidence reflecting true access. Systematic random sampling was done of 100 enrolled insured and 100 non-enrolled women who were willing to participate in the study from Daund and Haveli block of Pune district. A questionnaire was used as the data collecting tool. Statistical test were found to be significant 0.025 (<0.05) for occupation of women, 0.001 (<0.005) for caste of women and 0.023 (<0.05) for the education qualification of the women. Advance statistical test e.g. Multivariate analysis (binary logistic regression) shows the significant value of 0.002 (<0.005) for household expenditure above 6000 rupees, 0.006 (<0.05) for the higher primary education of women and 0.003 (<0.005) for the occupation of the head of the household. The average illness rate was 5.64 women/month for out-patient care among enrolled group and 4.20 person/month among non-enrolled. Seeking help from public hospital; private hospital; trust hospital and seeking help from clinics were the patterns of health seeking behaviors found in the study. Being an enrolled in CBHF increases the utilization of the health care services but at the same time there is no financial protection of money among the enrolled group. 14% women from the enrolled group were found to fall in catastrophic expenditure against 11% of women from the non-enrolled group. Therefore health insurance in study site of Pune increases utilization of health care services among the enrolled group at the same time it fail to protect the catastrophic events among the insured women than the non-ensured women.