The effect of health insurance on hospitalization: Identification of adverse selection, moral hazard and the vulnerable population in the Indian healthcare market

Sengupta, Reshmi; Rooj, Debasis

doi:10.1016/j.worlddev.2019.05.012

Cited by 25 publications

(25 citation statements)

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“…It may be due to the larger share of the elderly population were seen in the Southern region in India (Giridhar et al, 2014;United Nations Population Fund, 2017) and greater treatment-seeking behaviours (Banerjee, 2021;Dilip, 2002) because of the availability and accessibility of geriatric health-care facilities. Our finding has also highlighted that the elderly who were covered with health insurance support were significantly more likely to get hospitalised in India and were also reflected in other studies (Ranjan and Muraleedharan, 2020;Sahoo et al, 2021;Sengupta and Rooj, 2019;Sriram and Khan, 2020). The elderly who was fully economical dependent and immobile have the highest hospitalisation rate, also documented in previous studies.…”

Section: Discussionsupporting

confidence: 86%

Differentials and predictors of hospitalisation among the elderly people in India: evidence from 75th round of National Sample Survey (2017-2018)

Akhtar

Saikia

2022

WWOP

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Purpose There is limited evidence on the determinants of hospitalisation and its causes in India. This study aims to examine the differential in the hospitalisation rates and its socioeconomic determinants. This study also examines the causes of diseases in hospitalisation among the elderly (≥60 years) in India. Design/methodology/approach This study used data from the 75th round of the National Sample Survey Organizations, collected from July 2017 to June 2018. The elderly samples in this survey are 42,759, where 11,070 were hospitalised, and 31,689 were not hospitalised in the past year or 365 days. This study estimated hospitalisation rates and carried out binary logistic regression analysis to examine the associations of hospitalisation with the background variables. The cause of diseases in hospitalisations was also calculated. Findings The hospitalisation rate was lower among elderly female compared to elderly male. Elderly who belongs to middle-old aged groups, non-married, North-Eastern region, Southern region, general caste, health insurance, partially and fully economically dependent have a higher chance of being hospitalised. About 38% elderly were hospitalised due to communicable diseases (CDs), 52% due to non-communicable diseases (NCDs) and 10% due to injuries and others (IO). Nearly 40% elderly were hospitalised in public hospitals due to CDs, whereas 52% were hospitalised in private hospitals due to NCDs and 11% due to IO. Research limitations/implications Firstly, this study is based on cross-sectional survey due to which temporal ambiguity averted to draw causal inferences. Secondly, other significant factors can also predict hospitalisations and provide insightful results, such as lifestyle factors, behavioral factors, obesity, mental state and several personal habits such as smoking cigarettes, drinking alcohol, consuming tobacco or other harmful substances. But this information was not available in this study. Even with these limitations, the hospitalisation issues among the elderly are beneficial to understand the current circumstances of CDs, NCDs and injury and other diseases for India and its states to formulate health policy. Practical implications Early screening and early treatment for NCDs are needed, which are non-existent in almost all parts of India. It is essential to necessitate and identify the important factors that best predict hospitalisation or re-visit of hospital admission. Although, the medical advances in India have made rapid strides in the past few decades, it is burdened none the less, as the doctor–patient ratio is very low. It is important to develop preventive measures to minimize the accidents and causalities to avoid substantial cost associated with elderly health care. Social implications Raising awareness, promotion of healthy life style and improving the quality of good health-care provisions at primary level is a necessity. Originality/value The findings, practical and social implications provide a way forward for the health policymakers to potentially alter the future research to reduce associated comorbidities, unnecessary hospitalisations and other medical complications.

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Section: Discussionsupporting

confidence: 86%

Differentials and predictors of hospitalisation among the elderly people in India: evidence from 75th round of National Sample Survey (2017-2018)

Akhtar

Saikia

2022

WWOP

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“…It may be due to the larger share of the elderly population were seen in the Southern region in India 54,55 , and greater treatment-seeking behaviors 32,56 because of the availability and accessibility of geriatric healthcare facilities. Our finding has also highlighted that the elderly who were covered with health insurance support were significantly more likely to get hospitalized in India, and were also reflected in other studies 35,[57][58][59] . Elderly who was fully economical dependent and immobile have highest hospitalization rate which have been also documented in previous studies.…”

Section: Discussionsupporting

confidence: 82%

Differentials and predictors of hospitalization among the elderly people in India: Evidence from 75^thround of National Sample Survey (2017-18)

Akhtar

Saikia

2021

Preprint

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IntroductionThere are limited evidences on the determinants of hospitalization and its causes in India. We examined the differential in the hospitalization rates and its socio-economic determinants. We also examined the causes of diseases in hospitalization among the elderly (≥60 years) in India.MethodsWe used data from 75th round of the National Sample Survey Organizations (NSSO), collected from July 2017 to June 2018. The elderly samples in this survey are 42759, where 11070 were hospitalized, and 31,689 were not hospitalized in the last year or 365 days. We estimated hospitalization rates and carried out binary logistic regression analysis to examine the associations of hospitalization with the background variables. The cause of diseases in hospitalizations were also calculated.ResultsHospitalization rate was lower among female elderly compared to male elderly. Elderly who belongs to middle-old aged groups, non-married, North-Eastern region, Southern region, general caste, health insurance, partially & fully economically dependent elderly have a higher chance of being hospitalized. About 38% elderly were hospitalized due to communicable diseases (CDs), 52% due to non-communicable diseases (NCDs) and 10% due to Injuries & others. Nearly 40% elderly were hospitalized in public hospitals due to CDs, while 52% were hospitalized in private hospitals due to NCDs and 11% due to Injuries & others.ConclusionsRaising awareness, promoting a healthy lifestyle, and improving the quality of good healthcare provisions at the primary level is necessary. Early screening and early treatment for NCDs are needed, which is non-existent in almost all parts of India.

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“…Health insurance can play a significant role in reducing OOPE and financial burden by providing cashless health treatments (or reimbursement) to the insured in the empanelled hospitals. As stated by Sengupta and Rooj, 4 in India, health insurance can be an efficient tool to reduce or circumvent the financial burden of OOP spending. 5 The health insurance market in India is in the emerging stage.…”

Section: Introductionmentioning

confidence: 99%

Determinants of choice of health insurance: Empirical evidence from responses of Indian households

Yadav

Mohanty

2021

Health Planning & Management

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Health insurance has been accepted as one of the channels that can serve the purpose of universalisation of health care and especially useful in the period of health crisis. This is the emerging and challenging sector in India. The present study explores the health insurance penetration in India using the latest two rounds of nationally representative datasets of the National Family Health Survey (2005-06 and 2015-16). This study identifies the covariates of households' participation and their choice for different health insurance schemes, using the average marginal effects of binary and multinomial logit regression models with conditional categories after checking their Kernel density function. The results suggest that health insurance in India is more skewed towards the households belonging to higher wealth quintile and in the front runner states.Age, occupation and education level are also positively associated with health insurance enrolment. The variable 'weighted information index', which is estimated through Principal Component Analysis, is a significant determinant of private health insurance and community-based health insurance, and this also caters to the richer households. The study also identifies several shortcomings of not accessing health insurance, their choices and suggests reforms with the goal of universalization of healthcare. The robustness check has been performed using 20 percent, 50 percent and 80 percent sub-sampling of the models.

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The effect of health insurance on hospitalization: Identification of adverse selection, moral hazard and the vulnerable population in the Indian healthcare market

Cited by 25 publications

References 53 publications

Differentials and predictors of hospitalisation among the elderly people in India: evidence from 75th round of National Sample Survey (2017-2018)

Differentials and predictors of hospitalisation among the elderly people in India: evidence from 75th round of National Sample Survey (2017-2018)

Differentials and predictors of hospitalization among the elderly people in India: Evidence from 75^thround of National Sample Survey (2017-18)

Determinants of choice of health insurance: Empirical evidence from responses of Indian households

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The effect of health insurance on hospitalization: Identification of adverse selection, moral hazard and the vulnerable population in the Indian healthcare market

Cited by 25 publications

References 53 publications

Differentials and predictors of hospitalisation among the elderly people in India: evidence from 75th round of National Sample Survey (2017-2018)

Differentials and predictors of hospitalisation among the elderly people in India: evidence from 75th round of National Sample Survey (2017-2018)

Differentials and predictors of hospitalization among the elderly people in India: Evidence from 75thround of National Sample Survey (2017-18)

Determinants of choice of health insurance: Empirical evidence from responses of Indian households

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Product

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Differentials and predictors of hospitalization among the elderly people in India: Evidence from 75^thround of National Sample Survey (2017-18)