A qualitative comparative analysis of healthcare Supply–Demand side barriers under the publicly funded health insurance scheme in India

Saxena, Nitya; Singh, Prabal V.; Mishra, Abhishek

doi:10.4103/ijph.ijph_409_18

Cited by 5 publications

(5 citation statements)

References 10 publications

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“…This might result in great dissatisfaction unless both providers and CBHI members have become assertive in demanding immediate referral (12). Contrary to a study that reported waiting time as an unnecessary parameter for satisfaction (48), beneficiaries who perceived, expected, or received immediate care were more satisfied than those who did not. Whereas extended time to get healthcare service neither leads to satisfaction nor adherence to the CBHI scheme (49), beneficiaries spend prolonged time in the medical records, accounting, and pharmacy sections (31).…”

Section: Discussioncontrasting

confidence: 96%

Satisfaction of beneficiaries with community-based health insurance and associated factors in Legambo District, North-East Ethiopia: a cross-sectional study

Getaneh¹,

Bayked

Workneh

et al. 2023

Front. Public Health

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BackgroundThe fundamental concept of community-based health insurance is to strengthen the healthcare financing system to access universal healthcare by reducing costly risk-coping strategies. The scheme’s sustainability and the quality of services provided by it are highly dependent on the satisfaction of its beneficiaries. Despite beneficiaries’ satisfaction being the key determinant for providing evidence for policy revision and decision-making, it has often been neglected. Therefore, the study investigated the community-based health insurance beneficiaries’ satisfaction and associated factors in Legambo district, North-East Ethiopia.MethodsThe study was conducted in the Legambo district with a community-based cross-sectional study design from October to November 2019. The data were collected from 838 households that had been the beneficiaries of the scheme using multi-stage and systematic random sampling. Twelve trained data collectors were employed and gathered the data using a pre-tested, structured questionnaire. We ran descriptive, bivariate, and logistic regression analyses. A value of p less than 0.05 with a 95% CI was used in multivariate logistic regression to determine the association of variables with the beneficiaries’ satisfaction.ResultsThe overall satisfaction level of the beneficiaries of the scheme was 58.6% and was associated with the following factors: merchandize (AOR = 1.92, 95% CI = 1.02–3.63), living in rural areas (AOR = 1.52, 95% CI = 1.02–2.27), an early office opening time (AOR = 3.81, 95% CI = 2.04–7.10), a short time interval to use benefit packages (AOR = 4.85, 95% CI = 2.08–11.31), an inexpensive membership premium (AOR =10.58, 95% CI = 3.56–31.44), availability of laboratory services (AOR =2.95, 95% CI = 1.71–5.09), presence of referral services (AOR =1.93, 95% CI = 1.33–2.80), having immediate care at health facilities (AOR = 1.73, 95% CI = 1.01–2.97) and non-compulsory enrolment (AOR = 6.31, 95% CI = 1.64–24.20).ConclusionThe beneficiaries’ satisfaction with the scheme was suboptimal and found to be determined by occupation, residence, laboratory and referral services, immediate care, office opening time, time interval to use benefit packages, premium amount, and situation of enrollment, most of which are service-related variables. Thus, to improve the satisfaction level, the stakeholders that should work hard seem to be the health insurance agency (the insurer) and the health facilities (the provider or supplier).

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Section: Discussioncontrasting

confidence: 96%

Satisfaction of beneficiaries with community-based health insurance and associated factors in Legambo District, North-East Ethiopia: a cross-sectional study

Getaneh¹,

Bayked

Workneh

et al. 2023

Front. Public Health

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“…We found, for example, that technical assistance was being provided to improve the functioning of the health insurance program in India, mainly through supply-side interventions. However, there were legitimate reasons to hypothesize that the principal barriers to efficient and effective health care in these geographies were in fact demand-and supply-side constraints that were not covered through the interventions (Fadlallah et al, 2018;Saxena et al, 2019;Thakur, 2016). Even where data sets related to demand-side factors were unavailable, we sought to find other signals and proxy indicators to understand the impact of existing project activities.…”

Section: Discussionmentioning

confidence: 99%

Reflections on Required Competencies For Health Systems Monitoring, Evaluation, and Learning In India

Rao,

Nambiar

2023

J Multidiscip Eval

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The movement towards systems thinking and complexity-informed monitoring and evaluation has been ongoing for some time. Covid-19 has accelerated this shift and increased the salience of contextually aware, adaptive forms of evaluation. Drawing from our experience over three years of providing monitoring, evaluation, research and learning (MERL) to a large international philanthropic organization’s health systems portfolio of work in India, we identify three types of evaluator capacities and associated set of competencies that derive from complexity-driven practice in a developing country. The first type of capacity relates to deriving evidence in contexts where there are very few traditional forms of data. The MERL portfolio related to health systems outcomes of access, financial protection, and equity even as the health programs themselves were evolving in a period of rapid transformation and dynamism of policy priorities and implementation mechanisms. This required an integration of traditional performance indicators drawn from government datasets with qualitative ‘signals’ focused on drivers of change within the system. Assessment of signals in turn required synthesizing different sources of information, including informal channels of obtaining evidence such as partner meetings or government-sponsored events. The evaluating team thus consciously empowered different kinds of researchers with differential expertise with the goal of building a much more pixelated picture. The goal was not to identify a single source of truth but rather a patchwork of validated information where the relevance of different pieces of data were dependent on evolving outcomes of interest. The second set of competencies related to the skills required to play a convening role for donors and implementing partners, supporting better understanding of the changing operating context and help inform decision-making by program officers and partners. This involved building and sustaining relationships across different stakeholders at different stages of the project – from proposal development to review. Competencies relating to effective dialogue and developing an understanding of the core interests of international, national and sub-national partners as well as international donors and experts could only be developed iteratively and over time, but this was crucial in a distributed health decision-making ecosystem like India. The third and final set of competencies relate to operational adaptiveness, while evaluating an ecosystem with few constants. This can be the hardest competency to acquire because it is the farthest from the traditional notions embedded in the training of evaluation scientists and MERL practitioners. We found that the degree of buy-in and commitment to previously agreed upon frames of reference for evaluation can be shifted by changes in personnel or internal organizational structures. These shifts can lead to chain reactions of mismatched expectations that needed to be understood and managed in real time by MERL partners. The pandemic further created a natural experiment that on the one hand required a reexamination of program priorities and on the other depended on reliability of donor support. Each of these three types of capacities – synthesizing nuanced evidence for adaptive action, relationship building and communication, and managing operational discontinuities are in fact inter-dependent. Building evaluator competencies isn’t simply about capacity-building but rather a recognition of the diversity of skills and worldviews that need to be encompassed within our monitoring and evaluation functions for today’s complex, discontinuous health systems.

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“…The availability of medication is a required condition for the satisfaction of patients. For policymakers and implementers, the findings suggest identifying the segment that remains insecure under the scheme and gaining insights into the patient satisfaction parameters [1].…”

Section: Relevance In Health Sectormentioning

confidence: 99%

“…Till now, health infrastructure in India is good but not accessible to all people because of the weak planning to accommodate all the people irrespective of their income and social status. A significant part of the population lives in the rural area where health care facilities are not so good and people have to move towards the cities to avail the modern medical treatment or even rural people sometimes have not been able to avail the basic treatment for the critical disease [1].…”

Section: Introductionmentioning

confidence: 99%

Ayushman Bharat: An Ethical Analysis of the World’s Biggest Health Scheme

Bhola

Pradhan

2021

JPRI

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An affordable health scheme has been always required by the Indian people. Even after passing74 years of Indian independence, quality healthcare has not been accessible to the Indian people. The data have shown out of the vast population of India only 25 percent of people are insured under the private and government insurance scheme. To overcome this problem Indian government has launched the Ayushman Bharat scheme on 25 December 2018 on the occasion of the birth anniversary of Pt. Deen Dayal Upadhyaya. The Ayushman Bharat is the Hindi translation of “India blessed with long life”. This scheme is the biggest health care scheme in the world which covers the huge population of India and the covered population under this scheme is more than 100 million. The scheme has categories into the primary, secondary, and tertiary care domain to address the health-related problems of the people and the most important and fascinating feature of the scheme is that a beneficiary avails the facilities in government hospital along with private hospitals. The present study reviews different aspects of the scheme in relevance to the helath sector to provide better perpective towards Indian health care systems.

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A qualitative comparative analysis of healthcare Supply–Demand side barriers under the publicly funded health insurance scheme in India

Cited by 5 publications

References 10 publications

Satisfaction of beneficiaries with community-based health insurance and associated factors in Legambo District, North-East Ethiopia: a cross-sectional study

Satisfaction of beneficiaries with community-based health insurance and associated factors in Legambo District, North-East Ethiopia: a cross-sectional study

Reflections on Required Competencies For Health Systems Monitoring, Evaluation, and Learning In India

Ayushman Bharat: An Ethical Analysis of the World’s Biggest Health Scheme

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