Abstract
Research on impact of publicly financed health insurance has paid relatively little attention to the nature of healthcare provision the schemes engage. India’s National Health Insurance Scheme or RSBY was made universal by Chhattisgarh State in 2012. In the State, public and private sectors provide hospital services in a context of extensive gender, social, economic and geographical inequities. This study examined enrolment, utilization (public and private) and out of pocket (OOP) expenditure for the insured and uninsured, in Chhattisgarh. The Chhattisgarh State Central sample (n = 6026 members) of the 2014 National Sample Survey (71st Round) on Health was extracted and analyzed. Variables of enrolment, hospitalization, out of pocket (OOP) expenditure and catastrophic expenditure were descriptively analyzed. Multivariate analyses of factors associated with enrolment, hospitalization (by sector) and OOP expenditure were conducted, taking into account gender, socio-economic status, residence, type of facility and ailment. Insurance coverage was 38.8%. Rates of hospitalization were 33/1000 population among the insured and 29/1000 among the uninsured. Of those insured and hospitalized, 67.2% utilized the public sector. Women, rural residents, Scheduled Tribes and poorer groups were more likely to utilize the public sector for hospitalizations. Although the insured were less likely to incur out of pocket (OOP) expenditure, 95.1% of insured private sector users and 66.0% of insured public sector users, still incurred costs. Median OOP payments in the private sector were eight times those in the public sector. Of households with at least one member hospitalized, 35.5% experienced catastrophic health expenditures (>10% monthly household consumption expenditure).The study finds that despite insurance coverage, the majority still incurred OOP expenditure. The public sector was nevertheless less expensive, and catered to the more vulnerable groups. It suggests the need to further examine the roles of public and private sectors in financial risk protection through government health insurance.
Highlights
Universal health coverage and government health insurance schemesThe concept of Universal Health Coverage (UHC) arose out of a global concern for high levels of out of pocket expenditure for health care in many low- and middle-income countries (LMIC) [1]
38.8% were covered by any government insurance scheme, which includes both the universal insurance scheme and central and state schemes for government employees (Table 2)
A further 0.5% was covered with private insurance, while 60.7% of the sample had no insurance coverage of any kind
Summary
Universal health coverage and government health insurance schemesThe concept of Universal Health Coverage (UHC) arose out of a global concern for high levels of out of pocket expenditure for health care in many low- and middle-income countries (LMIC) [1]. Progress towards UHC requires strengthened health system functioning [1, 3,4,5,6] and a focus on equity [7,8,9,10,11]. Despite this broad vision, at country level, UHC has often focused on the establishment of state funded insurance schemes [12, 13] and stopped short of addressing the health systems strengthening or equity aspects of UHC. The impact of state funded insurance schemes on financial protection and health equity are currently a subject of keen debate the world over, including in India [5, 13,14,15,16]
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