Health Insurance In India Research Articles

Mass Media Exposure Moderates the Association of Education and Wealth with Enrollment in Health Insurance Among Older Adults Aged 60 Years and Older in India

ABSTRACT Mass media exposure (MME) plays an important role in changing health-related behavior or decision-making. This study aimed to examine the association of MME with enrollment in health insurance and its moderating effect on the associations of education and wealth with enrollment in health insurance among older adults in India. The data of 29,935 older adults aged 60 years and older from the first wave (baseline) of the Longitudinal Ageing Study in India (LASI-2017/18) were utilized. Descriptive statistics, bivariate analysis, multivariable logistic regression models, and Fairlie decomposition were used. The findings revealed that 18.3% of older adults had MME and enrollment in health insurance in India. Older adults with MME were 1.42 times more likely to be enrolled in health insurance than those with no MME, and years of schooling increased the probability of enrolling in health insurance compared to those who did not have formal schooling. With increasing monthly per capita expenditure (MPCE), the probability of enrolling in health insurance is lower than the poorest. Further, MME moderates the effects of education and MPCE on enrollment in health insurance and increases the likelihood of enrollment in health insurance. The study’s findings imply strategic communication plans to encourage health insurance enrollment in India should take into account the usage of these communication channels.

Women Left Behind: Gender Disparities in Utilization of Government Health Insurance in India

Women Left Behind: Gender Disparities in Utilization of Government Health Insurance in India

Advancing Cashless Treatment In Indian Healthcare Insurance: Benefits, Data Insights, And Strategic Steps

The Indian healthcare sector is experiencing a major shift, largely driven by progress in health insurance, especially in the area of cashless treatment options. This review article delves into the current landscape of health insurance in India, examines the advantages of cashless treatment, and outlines strategic measures to accelerate its adoption. Data from the fiscal year 2024 reveal a notable increase in insurance penetration and highlight the significant role of private sector participation. The article also presents a case study of Pristyn Care's efforts to reduce claim ratios, curb fraud, and extend services to underserved areas. These findings emphasize the ongoing need for enhancements in healthcare accessibility and efficiency through cashless treatment models

Performance Analysis in Health Insurance in India

Performance Analysis in Health Insurance in India

The Future of Health Insurance in India: A Case of Ayushman Bharat

Introduction: In 2017, the National Health Policy recommended the introduction of Ayushman Bharat to promote Universal Health Coverage (UHC), with the aim of providing comprehensive, need-based, and equitable healthcare services to the Indian population. The scheme comprises two primary components: the creation of 1,50,000 Health and Wellness Centres (HWCs) and the implementation of the Pradhan Mantri Jan Arogya Yojana (PM-JAY). These initiatives aim to enhance infrastructure related to comprehensive primary healthcare, maternal and child healthcare, non-communicable diseases, and improved drug delivery and diagnostic services. Out of 28 states and 8 Union territories in India, Delhi, Odisha, and West Bengal have not implemented the AB-PMJAY scheme. Telangana joined the scheme in May 2021, and each state has adopted different models to accommodate their healthcare requirements. Objective: The study elicits the various aspects of Ayushman Bharat, the scheme’s evolution throughout different timelines and its future prospects. Conclusion: The Ayushman Bharat scheme has played an enormous role in achieving comprehensive healthcare system by leveraging various technologies and digital health methods. During the pandemic, the rates of utilization have changed, and Ayushman Bharat is anticipated to contribute significantly to achieve UHC in the future.

Growth of Life and Non-life Insurance Market in India

In the midst of high cost of health care both at the macro and micro levels, health insurance becomes a viable alternative for financing health care in India. Health insurance is fast emerging as an important mechanism to finance health care needs of the people. The insurance industry in India has witnessed an impressive growth rate over the last two decades driven by the greater private sector participation and an improvement in distribution capabilities, along with substantial improvements in operational efficiencies. The paper presents the growth of life and non-life health insurance in India

Social and demographic determinants of health insurance status in India: Evidence from a nationally representative cross-sectional survey.

Out-of-pocket medical expenses are a crucial metric for assessing how well the healthcare system is working toward obtaining universal health coverage in any country. In India, out-of-pocket expenses for health are relatively high compared to other developed countries due to a lack of alternative finance arrangements. The disparity in out-of-pocket medical expenses largely depends upon the public health expenditure, government policies, and level of health insurance coverage. The study used a logit regression model to examine the association of the status of health insurance with socio and demographic variables using National Sample Survey 2018 data. The objective of the study is to analyze the impact of demographic variables on the status of health insurance in India. This research found that education and occupation have a significant impact on the status of health insurance, among other demographic factors. These findings underscore the importance of targeted policies and interventions aimed at improving access to health insurance among specific demographic groups. Addressing disparities in health insurance coverage based on educational and occupational factors is essential for achieving equitable healthcare access and improved health outcomes in the country. Increasing awareness of health insurance reduces out-of-pocket medical expenses and subsequently brings down economic poverty.

Mental Health Insurance in India: An Examination of Policy Implementation Post-MHCA 2017

Purpose of review: Owing to the high cost of care and huge treatment gap associated with mental illnesses in India, this review investigated the implementation of mental health insurance coverage in India following the mandate of the Mental Health Care Act of 2017 (MHCA 2017). Collection and analysis of data: We systematically identified health insurance providers in India through the Insurance Regulatory and Development Authority of India (IRDAI) website. We meticulously searched and obtained policy documents from either the IRDAI website or the respective insurance company websites. Our classification process involved determining if a policy explicitly covered mental illness, which we discerned by examining definitions of mental illness, indemnification clauses or the presence of International Classification of Diseases-10 codes within the policy. Conclusion: We evaluated 235 policies provided by 30 insurance companies and found that 37.5% (88) of policies covered mental illnesses, 11.5% (28) covered persons with disabilities, whereas 51% (119) did not offer any coverage. The majority of the companies did not cover suicide and substance use disorders. There are disparities in the outpatient care offerings, including extended waiting periods for coverage of mental illness. This review highlights the importance of aligning insurance practices with MHCA 2017s provisions to promote mental health equity in India. It also advocates for comprehensive mental health coverage that includes outpatient care, substance use disorders and suicide as well as a need for standardized definitions and transparent policy communication.

A step closer towards achieving universal health coverage: the role of gender in enrolment in health insurance in India

BackgroundThere is limited understanding of how universal health coverage (UHC) schemes such as publicly-funded health insurance (PFHI) benefit women as compared to men. Many of these schemes are gender-neutral in design but given the existing gender inequalities in many societies, their benefits may not be similar for women and men. We contribute to the evidence by conducting a gender analysis of the enrolment of individuals and households in India’s national PFHI scheme, Rashtriya Swasthya Bima Yojana (RSBY).MethodsWe used data from a cross-sectional household survey on RSBY eligible families across eight Indian states and studied different outcome variables at both the individual and household levels to compare enrolment among women and men. We applied multivariate logistic regressions and controlled for several demographic and socio-economic characteristics.ResultsAt the individual level, the analysis revealed no substantial differences in enrolment between men and women. Only in one state were women more likely to be enrolled in RSBY than men (AOR: 2.66, 95% CI: 1.32-5.38), and this pattern was linked to their status in the household. At the household level, analyses revealed that female-headed households had a higher likelihood to be enrolled (AOR: 1.36, 95% CI: 1.14-1.62), but not necessarily to have all household members enrolled.ConclusionFindings are surprising in light of India’s well-documented gender bias, permeating different aspects of society, and are most likely an indication of success in designing a policy that did not favour participation by men above women, by mandating spouse enrolment and securing enrolment of up to five family members. Higher enrolment rates among female-headed households are also an indication of women’s preferences for investments in health, in the context of a conducive policy environment. Further analyses are needed to examine if once enrolled, women also make use of the scheme benefits to the same extent as men do. India is called upon to capitalise on the achievements of RSBY and apply them to newer schemes such as PM-JAY.

Health Insurance in India: A look into Ayushman Bharat- Pradhan Mantri Jan Arogya Yojana

India had experienced rapid economic growth over the years and has been overtaking other countries both in terms of GNP and GNP (PPP). However, on social front, India’s performance is poor and is probably behind most of the important developing economies. While India does have some world-class health infrastructure providing topnotch treatment facilities, but they are way out of reach of the common people. These anomalies in the health sector have been recognized and taken in charge by the government through financial and human investment and also through various schemes and policies. Health insurance is one of the most popular health policy taken by the government and Ayushman Bharat is the latest one. This paper therefore discusses critically the Ayushman Bharat Scheme.

Health Insurance Business in India: Progress, Issues and Way Forward

India’s healthcare system is witnessing increased medical inflation, which is outpacing per capita Gross Domestic Product growth. With increased lifestyle diseases and, most recently, a pandemic caused by COVID-19, the cost of financing healthcare has become a huge issue, especially when government spending on healthcare is so low. In light of this, this article emphasises the significance of privately purchased, that is voluntary health insurance in addition to the government-sponsored health insurance programme for the vast uninsured population. Starting with the history of health insurance in India, this article examines premium growth, underwriting profit, investment income, net profit, incurred claims ratio and other metrics. Following that, the difficulties in the health insurance industry and their breadth are examined through a review of literature and recent newspaper reporting. The key issues resulting in negative underwriting experience are the inefficient risk pooling and unregulated private health care costs. A risk-sharing mechanism with an indemnification model must be implemented for better cost management to eliminate value fragmentation. Finally, ideas are given for resolving the challenges and increasing the market share of the health insurance company, with a focus on long-term business models such as managed care.

Linkage Between Health Insurance and Standard of Living with Special Reference to M East Ward of Mumbai

With the growth in the desk bound work forces the risk of our life increased a lot. Left with no stone unturned, the health insurance sector gaining popularity in India. At present, health insurance is one of the emerging sectors in India. Different stakeholders of this ecosystem, such as private health insurance companies, IRDAI, and other entities, are thriving each day to come up with the best health insurance policy for every citizen. Indians become the most active and engaged customers when it comes to health insurance. After pandemic, buying cashless health insurance online is a new normal. This increasing attention and awareness are due to rising medical inflation, advancements in medical sciences, pandemic, and critical illnesses. Thus, the Indian Health insurance market has come up with lucrative growth avenues and opportunities for companies and customers. In this context, the present study tries to analyse the linkage between health insurance and thereby better standard of living.

‘Having the card makes us feel worthless’: the negative value of government-funded health insurance in India

Since the 2000s, hundreds of government-funded health insurance (GFHI) schemes were introduced in India. These schemes are meant to prevent poorer households from incurring catastrophic health expenditures. Through GFHIs, policy-makers want to mobilize the decision-making powers of private consumers in a liberalized healthcare market. Patients are called upon to act as ‘co-creators’ of healthcare value by optimizing supply through demand. Based on long-term ethnographic fieldwork with insurance users in South India, we argue that GFHIs fail because people experience the value of insurance in drastically different ways that only partly overlap with how the policy assumes they value insurance. In addition, the hollow promises of health coverage can be experienced as so frustrating that signing up for health insurance actually makes people feel devalued.

Study on awareness of health insurance among the adult population of rural areas in the Wardha district of Maharashtra: a protocol

Introduction: Globally, the foundation of health insurance is substantial. However, the Indian health insurance sector lags. Only 14.1% of the rural population is covered by health insurance. That is, 85.9% of individuals in rural India still lack any form of health expenditure coverage and are unaware and thus are uninsured. Despite all the efforts made by the health system to assist the Indian population with supporting their healthcare finances, the public is unable to use these services simply because they are unaware of them. Individuals without health insurance will experience impoverishment due to health-related problems. Increased health insurance awareness can also be an indicator of universal health coverage. The objective is to study rural community individuals' awareness, perception, and utilisation of health insurance and to determine the association between sociodemographic variables and awareness of health insurance. Methods: The study will be a community based cross-sectional and observational study design in the Wardha district of Maharashtra from September 2023. Individuals within the region who are over 18 and at home during the visit will be included in the study. Individuals under the age requirement, and any empty households during the visits will be excluded. A pre-designed and semi structured questionnaire will be used. House-to-house visits will be done and information will be obtained by interviews. SPSS 24.0 software will be used for the data analysis. Variables included are name, age, sex, type of family, occupation, and knowledge of health insurance. Conclusions: The results of this study will involve an assessment of the participant’s awareness, perception, and utilisation of health insurance, and the association between socio demographic variables and awareness of health insurance. Descriptive statistics like frequency and percentages will be calculated. Chi-square test will be used for association between variables.

Spatial Patterns in the Distribution of Hypertension among Men and Women in India and Its Relationship with Health Insurance Coverage.

The present study explores district-level data associated with health insurance coverage (%) and the prevalence of hypertension (mildly, moderately, and severely elevated) observed across men and women as per NFHS 5. Coastal districts in the peninsular region of India and districts in parts of northeastern India have the highest prevalence of elevated blood pressure. Jammu and Kashmir, parts of Gujarat and parts of Rajasthan have a lower prevalence of elevated blood pressure. Intrastate heterogeneity in spatial patterns of elevated blood pressure is mainly seen in central India. The highest burden of elevated blood pressure is in the state of Kerala. Rajasthan is among the states with higher health insurance coverage and a lower prevalence of elevated blood pressure. There is a relatively low positive relationship between health insurance coverage and the prevalence of elevated blood pressure. Health insurance in India generally covers the cost of inpatient care to the exclusion of outpatient care. This might mean that health insurance has limited impact in improving the diagnosis of hypertension. Access to public health centers raises the probability of adults with hypertension receiving treatment with antihypertensives. Access to public health centers has been seen to be especially significant at the poorer end of the economic spectrum. The health and wellness center initiative under Ayushman Bharat will play a crucial role in hypertension control in India.

Growth of Health Insurance in India

Growth of Health Insurance in India

Can beneficiary information improve hospital accountability? Experimental evidence from a public health insurance scheme in India

We study the role of hospital compliance in the effectiveness of government health insurance in India. Using patient surveys, we document that participating hospitals charge unauthorized fees to poor patients eligible to receive free care. Average out-of-pocket payments (OOPP) for chronic kidney care patients are $43 per month, or 25% annual GDP per capita, and are high at both public and private hospitals. Awareness of program benefits is low despite patients having used insurance for several months. We conduct a randomized experiment to test whether phone-based information about program benefits can enable insurance beneficiaries to hold hospitals accountable and lower OOPP. The intervention effectively increases program awareness by 0.17 standard deviations but has no effect on OOPP overall. However, effects differ dramatically by hospital sector: patients at private hospital see no change in OOPP despite increased bargaining and search; monthly OOPP among patients visiting public hospitals, who are poorer and lower caste, drop by $12 (35%), because they are able to negotiate to get more of their benefits at the hospital instead of paying for them off-site. The findings suggest that patient-driven accountability can meaningfully improve public service delivery, even in the context of specialized tertiary care, but may not substitute for top-down monitoring of private agents.

Mental Health Insurance in India and Other Countries: A Comparative Perspective

Improved health and health coverage are of vital concern to the welfare of Indian society. The nascent health insurance system of a country is experiencing an explosive expansion and various models of schemes but lacking mental health coverage. This article discusses the effect of different systems of health coverage and insurance and develops a system of health coverage in India.

Health insurance in India: a study on premium insight

Health insurance in India: a study on premium insight

Pathways to reimagining commercial health insurance in India.

In this paper we explore how India's growing commercial health insurance (CHI) segment can be reformed to deliver adequate financial protection and good health outcomes. We lay out key issues in the demand- and supply-sides of the insurance market that need to be addressed for CHI to be more aligned toward universal health coverage (UHC). On the demand side, we identify a consumer who strays far from the rational actor paradigm and therefore one whose needs require a fundamentally different approach than the one that commercial health insurance in India has so far taken. We lay out precisely the different stages involved in bringing a consumer to the insurance market and the conditions under which that consumer is likely to purchase insurance. On the supply side, we describe the many concerns that a new entrant into the commercial health insurance market must grapple with. We conclude with a set of pathways that brings the two sides of the market together to shed light on possible pathways for reform in the commercial health insurance sector in India. Despite the many challenges that this sector faces in India, we believe that there is room for optimism, and with the right amount of regulatory foresight, even room for radical transformation.