INTER-STATE DISPARITIES IN HEALTHCARE COSTS, HEALTH INSURANCE COVERAGE AND FINANCIAL PROTECTION IN INDIA: A COMPARATIVE ANALYSIS OF NATIONAL SAMPLE SURVEYS FOR 1986-87, 1995-96, 2004 AND 2014
DOI:
https://doi.org/10.29121/ijetmr.v10.i5.2023.1315Keywords:
Health Insurance Coverage, Financial Protection, Healthcare CostsAbstract
By analysing data from the National Sample Survey for four rounds (1986–87, 1995–96, 2004 and 2014) this research focuses on changes in people's health seeking behaviour, the cost of treatment, and principal factors affecting health insurance premium payments by BPL and APL families. With variations between states, it is discovered that over time, less people sought care from public providers and more people preferred private providers. Despite the fact that both men and women are now more likely to seek treatment for their illnesses, a sizeable portion of the population (more in rural than in urban areas), still refuses treatment because they believe their illness is not serious enough to warrant it. Whilst the cost of healthcare has gone up over time, the difference between public and private costs of treatment has shrunk, possibly as a result of the higher recurring cost in public health facilities and imposing of user fees and cutting on the delivery of free medication. Since the middle of the 2000s, public insurance companies have offered low-cost hospitalisation insurance programmes like the Jan Arogya Bima Policy and Rashtriya Swasthya Bima Yojana (RSYB) to help with the healthcare needs of the underprivileged sector of society. According to the insurance premiums, more households that paid premiums in 2004 and 2014 belonged to groups with higher Monthly Per Capita Expenditures (MPCE) and were not economically in the poorest tier. The inter-quintile MPCE differential (between the top and bottom quintile) also reveals significant inter-state disparities in terms of the percentage of households that paid a premium and the percentage of households that had health insurance. The factors that determine whether a family enrols in health insurance imply that increasing enrolment from the poor households got coverage through RSBY. At the national level, BPL/APL households with insurance reported, on average, higher hospitalisation costs than non-insured households, with the difference being significantly higher for urban households. This finding suggests the prevalence of insurance collusion and moral hazard, particularly in the cities from developed states of Punjab, Haryana, Gujarat, and Maharashtra. Further, BPL households, particularly from rural India, have received very little financial relief as a result of the insurance.
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References
Balarajan, Y., Selvaraj, S., & Subramanian, S. V. (2011). Health Care and Equity in India, Lancet, 377(9764), 505–515. https://doi.org/10.1016/S0140-6736(10)61894-6 DOI: https://doi.org/10.1016/S0140-6736(10)61894-6
Berman, P., Ahuja, R., & Bhandari, L. (2010). The Impoverishing Effect of Health Care Payments in India: New Methodologies and Findings, Economic and Political Weekly, 45(16), 65–71. https://www.jstor.org/stable/25664359
Bhat, R., & Jain, N. (2006). Analysis of Public Private Healthcare Expenditures, Economic and Political Weekly, 41(1), 57–68. https://www.jstor.org/stable/4417643
Deolalikar, A. B., Jamison, D. T., Jha, P., & Laxminarayan, R. (2008). Financing health improvements in India, Health Affairs, 27(4), 978–990. https://doi.org/10.1377/hlthaff.27.4.978 DOI: https://doi.org/10.1377/hlthaff.27.4.978
Fan, V. Y., Karan, A., & Mahal, A. (2012). State Health Insurance and Out-Of-Pocket Health Expenditures in Andhra Pradesh, India, International Journal of Health Care Finance and Economics, 12(3), 189–215. https://doi.org/10.1007/s10754-012-9110-5 DOI: https://doi.org/10.1007/s10754-012-9110-5
Government of India. (1989). National Sample Survey Organisation: Consumer Expenditure for All India, 42nd Round, Report no. 355/2, Department of Statistics.
Government of India. (1998). National Sample Survey Organisation: Morbidity and Treatment of Ailments, 52nd Round, Report no. 441, Department of Statistics.
Government of India. (2005). Ministry of Health and Family Welfare (MOHFW), Report of the National commission on macroeconomics and health, 2005, MOHFW.
Government of India. (2006). National Sample Survey Organisation: Social Consumption Healthcare and Condition of the Aged, 60th Round, Report no. 507, Ministry of Statistics and Programme Implementation.
Government of India. (2016). National Sample Survey Organisation: Health in India, NSS 71st Round (January–June 2014), Report no. 574, 71/25(0), Ministry of Statistics and Programme Implementation.
Government of India. (2022). National health accounts estimates for India 2018–19, Ministry of Health and Family Welfare.
Government of India. (2018). Directorate General of Health Services (DGHS), Ministry of Health and Family Welfare (MOHFW) National Health Profile 2018, Central Bureau of Health Intelligence, DGHS, MOHFW.
Ghosh, S. (2014). Publicly Financed Health Insurance for the Poor Understanding RSBY in Maharashtra, Economic and Political Weakly, 46(20), 56–63. https://www.jstor.org/stable/24480998
Gumber, A. (1997). Burden of Disease and Cost of Ill Health in India: Setting Priorities for Health Interventions During The Ninth Plan, Margin, 29(2), 133–172.
Gumber, A. (2000). Health Care Burden on Households in the Informal Sector: Implications for Social Security Assistance, Indian Journal of Labour Economics, 43(2), April-June, 277–291. https://www.researchgate.net/profile/Anil-Gumber/publication/286988707_Health_care_burden_on_households_in_the_informal_sector_Implications_for_social_security_assistance/links/580f96ea08aea04bbcba5ae0/Health-care-burden-on-households-in-the-informal-sector-Implications-for-social-security-assistance.pdf
Gumber, A. (2002). Economic Reforms and the Health Sector: Towards Health Equity in India. In Institute of Applied Manpower Research, Reform and Employment, Concept Publishing House, 235–284. https://books.google.com/books?hl=en&lr=&id=HH3k6FHwxx8C&oi=fnd&pg=PA235&dq=Gumber,+A.+(2002).+Economic+Reforms+and+the+Health+Sector:+Towards+Health+Equity+in+India.+In+Institute+of+Applied+Manpower+Research,+Reform+and+Employment,+Concept+Publishing+House,+235%E2%80%93284.&ots=5E9xIFAXQr&sig=z6edzBv2uvirWV9qSenVzj95Z7k
Gumber, A. (2021). Equity in Healthcare Utilisation and Cost of Treatment in Western India, Journal of Social and Economic Development, 23(S1), 131–152. https://doi.org/10.1007/s40847-020-00121-1 DOI: https://doi.org/10.1007/s40847-020-00121-1
Gumber, A., Lalitha, N., & Dhak, B. (2017). Rising Healthcare Costs and Universal Health Coverage in India: An Analysis of National Sample Surveys, 1986–2014, GIDR Working Paper no. 246. Gujarat Institute of Development Research. https://shura.shu.ac.uk/21618/
Hooda, S. K. (2015). Private Sector in Healthcare Delivery market in India: Structure, Growth and Implications. ISID Working Paper 185. New Delhi: Institute for Studies in Industrial Development. https://ideas.repec.org/p/sid/wpaper/185.html
Jakab, M., & Krishnan, C. (2001). Community Involvement in Health Care: A Survey of the Literature on the Impact, Strengths and Weaknesses. Report Submitted to Working Group 3 of the Commission on Macroeconomics and Health, Jeffrey D. Sachs (Chairman), World Health Organization. https://openknowledge.worldbank.org/entities/publication/c1318fce-a4f1-57fd-b5d4-6c6f6eadebcb
Lalitha, N. (2009). Access to Medicines in Public Health Care: Lessons from Tamil Nadu. In G. Kumar (Ed.), Health Sector Reforms in India, New Delhi: Manohar Publishers and Centre De Sciences Humaines, 87–113.
Rajasekhar, D., Berg, E., Ghatak, M., Manjula, R., & Roy, S. (2011). Implementing Health Insurance: The Roll Out of Rashtriya Swasthya Bima Yojana in Karnataka. Economic and Political Weakly, 46(20), 56–63. https://www.jstor.org/stable/23018214
Selvaraj, S., & Karan, A. (2009). Deepening Health Insecurity in India: Evidence from National Sample Surveys Since 1980s. Economic and Political Weekly, 44(40), 55–60. https://www.jstor.org/stable/25663657
Sen, G., Iyer, A., & George, A. (2002). Structural Reforms and Health Equity: A Comparison of NSS Surveys 1986–87 and 1995–96. Economic and Political Weekly, 37(14), 1342–1352. https://www.jstor.org/stable/4411960
Sen, G. (2003). Inequalities and Health in India. Development, 46(2), 18–20. https://doi.org/10.1057/palgrave.development.1110438 DOI: https://doi.org/10.1057/palgrave.development.1110438
Shariff, A., & Mondal, S. K. (2009). User Fee in Public Health Care Institutions. In G. Mondal (Ed.), Health Sector Reforms in India, New Delhi: Manohar Publishers and Centre De Sciences Humaines, 147–168.
Sundarraman, T., & Muraleedharan, V. R. (2015). Falling Sick, Paying the Price NSS 71st Round on Morbidity and Costs of Healthcare, Economic and Political Weekly, Vol L (33), August, 17–20. https://www.epw.in/journal/2015/33/commentary/falling-sick-paying-price.html
Van Doorslaer, E., O’Donnell, O., Rannan-Eliya, R. P., Somanathan, A., Adhikari, S. R., Garg, C. C., Harbianto, D., Herrin, A. N., Huq, M. N., Ibragimova, S., Karan, A., Ng, C. W., Pande, B. R., Racelis, R., Tao, S., Tin, K., Tisayaticom, K., Trisnantoro, L., Vasavid, C., & Zhao, Y. (2006). Effect of payments for health care on poverty estimates in 11 countries in Asia: An analysis of household survey data. Lancet, 368(9544), 1357–1364. https://doi.org/10.1016/S0140-6736(06)69560-3 DOI: https://doi.org/10.1016/S0140-6736(06)69560-3
World, B. (2001). India-Raising the Sights: Better Health Systems for India’s Poor, World Bank.
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