Uncovering Coverage: Utilisation of the Universal Health Insurance Scheme, Chhattisgarh by Women in Slums of Raipur

Nandi, Sulakshana; Dasgupta, Rajib; Garg, Samir; Sinha, Dipa; Sahu, Sangeeta; Mahobe, Reeti

doi:10.1177/0971521515612863

Cited by 25 publications

(24 citation statements)

References 12 publications

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“…Where OOP expenditure was incurred, amounts were eight times higher in private than in public facilities for people covered with insurance. Previous work in Chhattisgarh [ 72 , 94 ] by the authors, and by Rent & Ghosh [ 75 ] in neighbouring Maharashtra has found similar differences. It is pertinent to note that in Chhattisgarh, the private sector receives the major share (82.9%) of claim amounts, and accounts for two-third of hospitalizations under the scheme [ 82 ].…”

Section: Discussionsupporting

confidence: 61%

Hospital utilization and out of pocket expenditure in public and private sectors under the universal government health insurance scheme in Chhattisgarh State, India: Lessons for universal health coverage

2017

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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.

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Section: Discussionsupporting

confidence: 61%

Hospital utilization and out of pocket expenditure in public and private sectors under the universal government health insurance scheme in Chhattisgarh State, India: Lessons for universal health coverage

2017

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“…Mechanisms such as the biometric smart card and information technology-based billing systems are supposed to enable real-time data, patient access to information and transparency. However, studies have found that patients are often not told about the amounts deducted from their insurance smart card nor given receipts [104,115,119]. Some rural area facilities faced problems in utilising the scheme due to the lack of regular internet connectivity [61].…”

Section: Impact On Health Systemmentioning

confidence: 99%

Using an equity-based framework for evaluating publicly funded health insurance programmes as an instrument of UHC in Chhattisgarh State, India

Nandi

Schneider

2020

Health Res Policy Sys

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Background: Universal health coverage (UHC) has provided the impetus for the introduction of publicly funded health insurance (PFHI) schemes in the mixed health systems of India and many other low-and middle-income countries. There is a need for a holistic understanding of the pathways of impact of PFHI schemes, including their role in promoting equity of access. Methods: This paper applies an equity-oriented evaluation framework to assess the impacts of PFHI schemes in Chhattisgarh State by synthesising literature from various sources and highlighting knowledge gaps. Data were collected from an extensive review of publications on PFHI schemes in Chhattisgarh since 2009, including empirical studies from the first author's PhD and grey literature such as programme evaluation reports, media articles and civil society campaign documents. The framework was constructed using concepts and frameworks from the health policy and systems research literature on UHC, access and health system building blocks, and is underpinned by the values of equity, human rights and the right to health. Results: The analysis finds that evidence of equitable enrolment in Chhattisgarh's PFHI scheme may mask many other inequities. Firstly, equitable enrolment does not automatically lead to the acceptability of the scheme for the poor or to equity in utilisation. Utilisation, especially in the private sector, is skewed towards the areas that have the least health and social need. Secondly, related to this, resource allocation patterns under PFHI deepen the 'infrastructure inequality trap', with resources being effectively transferred from tribal and vulnerable to 'better-off' areas and from the public to the private sector. Thirdly, PFHI fails in its fundamental objective of effective financial protection. Technological innovations, such as the biometric smart card and billing systems, have not provided the necessary safeguards nor led to greater accountability. Conclusion: The study shows that development of PFHI schemes, within the context of wider neoliberal policies promoting private sector provisioning, has negative consequences for health equity and access. More research is needed on key knowledge gaps related to the impact of PFHI schemes on health systems. An over-reliance on and rapid expansion of PFHI schemes in India is unlikely to achieve UHC.

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“…In India the first insurance scheme, Rashtriya Swasthya Bima Yojana, began in 2007-08, being implemented in 457 out of 687 districts, mainly in states that have agreed to cofinance the scheme. [30][31][32] Pakistan launched its Prime Minister's insurance based National Health Scheme in 2014 but it operates only in selected districts in two provinces where the ruling party is in power and in federally administered areas. 22…”

Section: Recent Policy Initiativesmentioning

confidence: 99%

Expanding access to healthcare in South Asia

Zaidi

Saligram

Ahmed

et al. 2017

BMJ

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Uncovering Coverage: Utilisation of the Universal Health Insurance Scheme, Chhattisgarh by Women in Slums of Raipur

Abstract: In 2013, the National Urban Health Mission (NUHM) was rolled out to effectively address health concerns of the urban poor population.

Cited by 25 publications

References 12 publications

Hospital utilization and out of pocket expenditure in public and private sectors under the universal government health insurance scheme in Chhattisgarh State, India: Lessons for universal health coverage

Hospital utilization and out of pocket expenditure in public and private sectors under the universal government health insurance scheme in Chhattisgarh State, India: Lessons for universal health coverage

Using an equity-based framework for evaluating publicly funded health insurance programmes as an instrument of UHC in Chhattisgarh State, India

Expanding access to healthcare in South Asia

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