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.
Highlights
Universal health coverage (UHC) has become an important stated policy goal in several developing countries [1]
No significant association was observed in multivariate analysis between hospitalization rate, choice of care provider or catastrophic health expenditures (CHE) with insurance status or Rashtriya Swasthiya Bima Yojna (RSBY) in particular
In order to assess the effect of the insurance, we considered assessing the OP utilization patterns along with IP as some of Government schemes and social health insurance (SHI) provide both OP and IP care coverage whereas RSBY and private insurance schemes limit the cover to IP care
Summary
Universal health coverage (UHC) has become an important stated policy goal in several developing countries [1]. In a paradigm shift to the earlier policy, several publicly financed health insurance schemes were launched at the Central and State level during the period from 2007–2010 These schemes include the Rashtriya Swasthiya Bima Yojna (RSBY)– called Rashtriya Swasthya Suraksha Yojana (RSSY) at central level and; Rajiv Aarogyasri scheme (RAS) in Andhra Pradesh, Rajiv Gandhi Jeevandayee Arogya Yojna (RGJAY) in Maharashtra and Chief Minister’s Comprehensive Health Insurance scheme (CMCHIS) in Tamil Nadu, all at state level [6,7,8,9]. We assess the relationship of HI and RSBY on out-of-pocket (OOP) expenditures and financial risk protection (FRP)
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