Revisiting equity in healthcare spending through capability-approach: assessing the effectiveness of health-insurance schemes in reducing OOPE and CHE in India

2020 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Rinshu Dwivedi ◽  
Jalandhar Pradhan
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Capability Approach ◽  
Financial Burden ◽  
Private Insurance ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
Sample Survey ◽  
Content Type ◽  
The Impact

Purpose This paper aims to draw theoretical insight from Sen’s capability-approach and attempts to examine the effectiveness of health-insurance-schemes in reducing out-of-pocket-expenditure (OOPE) and catastrophic-health-expenditure (CHE) in India. Design/methodology/approach Data were extracted from the National-Sample-Survey-Organization, 71st round on Health-2014. Generalized-linear-regression-model was used to investigate the impact of social-protection-schemes on OOPE and CHE. Findings A notable segment of the Indian population is still not covered under any health-insurance-schemes. The majority of the insured population was covered by publicly-financed-health-insurance-schemes (PFHIs), with a trivial-share of private-insurance. Households from 16–59 age-group, urban, literate, richest, southern-regions, using private-facilities and having ear and skin ailments have reported higher insurance coverage. Reimbursement was higher among elderly, literates, middle-class, central-regions, using private-facilities/insurance and for infections. Access to PFHIs significantly reduces the risk of OOPE and CHE. Unavailability of reimbursement exposes the population to a higher risk of CHE. Research limitations/implications Being a study based on secondary data sources, its applicability may vary as per the other social indicators. Practical implications Extending insurance-coverage alone cannot answer the widespread inequalities in health care. Rather, an efficiently managed reimbursement-mechanism could condense OOPE and CHE by enhancing the capability of the population to confront the undue financial burden. Social implications Extending the health-insurance-coverage to the entire population requires a better understanding of the underlying-dynamics and health-care needs and must make health-care affordable by enhancing the overall capability. Originality/value This research brings a theoretical and conceptual analysis for improving the health-insurance coverage among the community as a public health strategy.

Autism and Families' Financial Burden: The Association With Health Insurance Coverage

2015 ◽  
Vol 120 (2) ◽  
pp. 166-175 ◽  
Author(s):  
Susan L. Parish ◽  
Kathleen C. Thomas ◽  
Christianna S. Williams ◽  
Morgan K. Crossman
Keyword(s):  
Health Insurance ◽  
Medical Expenditure Panel Survey ◽  
Financial Burden ◽  
Private Insurance ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
Autism Spectrum ◽  
Medical Expenditure ◽  
Outpatient Services ◽  
Raising Children

Abstract We examined the relationship between family financial burden and children's health insurance coverage in families (n  =  316) raising children with autism spectrum disorders (ASD), using pooled 2000–2009 Medical Expenditure Panel Survey data. Measures of family financial burden included any out-of-pocket spending in the previous year, and spending as a percentage of families' income. Families spent an average of $9.70 per $1,000 of income on their child's health care costs. Families raising children with private insurance were more than 5 times as likely to have any out-of-pocket spending compared to publicly insured children. The most common out-of-pocket expenditure types were medications, outpatient services, and dental care. This study provides evidence of the relative inadequacy of private insurance in meeting the needs of children with ASD.

scholarly journals Problems of health insurance coverage and health care in the United States: public and private solution strategies

1992 ◽  
Vol 8 (3) ◽  
pp. 270-286
Author(s):  
E. Richard Brown
Keyword(s):  
United States ◽  
Health Care ◽  
Health Insurance ◽  
Private Insurance ◽  
Insurance Coverage ◽  
Health Care Financing ◽  
Health Insurance Coverage ◽  
The United States ◽  
Political Debate ◽  
Financing System

A nearly universal consensus has developed in the United States that the current health care financing system is a failure. The system has been unable to control the continuing rapid rise in health care costs (by far, the highest in the world), and it has been unable to stem the growing population that has no health insurance coverage (at least 36 million people). There is nearly universal political agreement that government must provide health insurance to a far greater share of the population than ever before. The political debate now focuses on whether this expanded government role should supplement the private insurance system with an enlarged public program covering those left out of private insurance coverage, or replace private insurance with a universal government health insurance program covering the entire population.

scholarly journals The Impact of Health Insurance Coverage on Health Care of School Children

1967 ◽  
Vol 82 (4) ◽  
pp. 323 ◽  
Author(s):  
Joy G. Cauffman ◽  
Milton I. Roemer ◽  
Carl S. Shultz
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
School Children ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
The Impact

scholarly journals Iran health insurance system in transition: equity concerns and steps to achieve universal health coverage

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Leila Doshmangir ◽  
Mohammad Bazyar ◽  
Arash Rashidian ◽  
Vladimir Sergeevich Gordeev
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Health Equity ◽  
Universal Health Coverage ◽  
Insurance Coverage ◽  
Health Care Expenditures ◽  
Health Insurance Coverage ◽  
Health Coverage ◽  
The Impact ◽  
Universal Health

Abstract Background Equity, efficiency, sustainability, acceptability to clients and providers, and quality are the cornerstones of universal health coverage (UHC). No country has a single way to achieve efficient UHC. In this study, we documented the Iranian health insurance reforms, focusing on how and why certain policies were introduced and implemented, and which challenges remain to keep a sustainable UHC. Methods This retrospective policy analysis used three sources of data: a comprehensive and chronological scoping review of literature, interviews with Iran health insurance policy actors and stakeholders, and a review of published and unpublished official documents and local media. All data were analysed using thematic content analysis. Results Health insurance reforms, especially health transformation plan (HTP) in 2014, helped to progress towards UHC and health equity by expanding population coverage, a benefits package, and enhancing financial protection. However, several challenges can jeopardize sustaining this progress. There is a lack of suitable mechanisms to collect contributions from those without a regular income. The compulsory health insurance coverage law is not implemented in full. A substantial gap between private and public medical tariffs leads to high out-of-pocket health expenditure. Moreover, controlling the total health care expenditures is not the main priority to make keeping UHC more sustainable. Conclusion To achieve UHC in Iran, the Ministry of Health and Medical Education and health insurance schemes should devise and follow the policies to control health care expenditures. Working mechanisms should be implemented to extend free health insurance coverage for those in need. More studies are needed to evaluate the impact of health insurance reforms in terms of health equity, sustainability, coverage, and access.

RSBY: delivering health insurance through public-private contracting

2020 ◽  
Vol 10 (4) ◽  
pp. 1-36
Author(s):  
Dayashankar Maurya ◽  
Amit Kumar Srivastava ◽  
Sulagna Mukherjee
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Low Income ◽  
Insurance Coverage ◽  
Health Care Expenditure ◽  
Health Insurance Coverage ◽  
Insurance Companies ◽  
Content Type ◽  
Academic Level ◽  
Public And Private Sector

Learning outcomes The central lesson to be learned from studying the case is to understand the challenges and constraints posed by contextual conditions in designing contracts in public–private partnerships (PPP) for financing and delivering health care in emerging economies such as India. Case overview/synopsis Perverse incentives, along with contextual conditions, led to extensive opportunistic behaviors among involved agencies, limiting the effectiveness of otherwise highly regarded innovative design of the program. Complexity academic level India’s “Rashtriya Swasthya Bima Yojana” or National Health Insurance Program, launched in 2007 provided free health insurance coverage to protect millions of low-income families from getting pushed into poverty due to catastrophic health-care expenditure. The program was implemented through a PPP using standardized contracts between multiple stakeholders from the public and private sector – insurance companies, hospitals, intermediaries, the provincial and federal government. Supplementary materials Teaching Notes are available for educators only. Subject code CSS: 10 Public Sector Management.

scholarly journals Assessing the Impact of Health Insurance and Other Socioeconomic Factors on Inequality in Health Care Expenditures among Farm Households

2015 ◽  
Vol 44 (1) ◽  
pp. 35-64
Author(s):  
Hisham S. El-Osta
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Socioeconomic Factors ◽  
Insurance Coverage ◽  
Positive Association ◽  
Health Care Expenditures ◽  
Health Insurance Coverage ◽  
Farm Households ◽  
Inequality In Health ◽  
The Impact

This research uses data from the 2005–2011 Agricultural Resource Management Survey and a two-part-model regression procedure to examine the impact of health insurance and other relevant socioeconomic factors on the distribution of health care expenditures among U.S. farm households. Findings show the importance of privately acquired health insurance coverage in explaining inequality in health care expenditures. The results also reveal, among other things, a statistical positive association between health care expenditures and farm operators who fall into the baby boomer age category. A similar statistical association is found for higher income levels but not for inequality of income.

scholarly journals The Personal Financial Burden of Chronic Rhinosinusitis: A Canadian Perspective

2017 ◽  
Vol 31 (4) ◽  
pp. 216-221 ◽  
Author(s):  
Jonathan Yip ◽  
Allan D. Vescan ◽  
Ian J. Witterick ◽  
Eric Monteiro
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Chronic Rhinosinusitis ◽  
Health Care System ◽  
Financial Burden ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
Perceived Burden ◽  
Snot 22 ◽  
Care System

Background Previous studies describe the financial burden of chronic rhinosinusitis (CRS) from the perspective of third-party payers, but, to our knowledge, none analyze the costs borne by patients (i.e., out-of-pocket expenses [OOPE]). Furthermore, this burden has not been previously investigated in the context of a publicly funded health care system. Objective The purpose of this study was to characterize the financial impact of CRS on patients, specifically by evaluating its associated OOPEs and the perceived financial burden. The secondary aim was to determine the factors predictive of OOPEs and perceived burden. Methods Patients with CRS at a tertiary care sinus center completed a self-administered questionnaire that assessed their socioeconomic characteristics, disease-specific quality of life (22-item Sino-Nasal Outcome Test [SNOT-22]), workdays missed due to CRS, perceived financial burden, and direct medical and nonmedical OOPEs over a 12-month period. Total OOPEs were calculated from the sum of direct medical and nonmedical OOPEs. Regression analyses determined factors predictive of OOPEs and the perceived burden. Results A total of 84 patients completed the questionnaires. After accounting for health insurance coverage and the median direct medical, direct nonmedical, and total OOPEs per patient over a 12-month period were Canadian dollars (CAD) $336.00 (2011) [U.S. $339.85], CAD $129.87 [U.S. $131.86], and CAD $607.10 [U.S. $614.06], respectively. CRS resulted in an average of 20.6 workdays missed over a 12-month period. Factors predictive of a higher financial burden included younger age, a greater number of previous sinus surgeries, <80% health insurance coverage, residing out of town, and higher SNOT-22 scores. Conclusion Total OOPEs incurred from the treatment of CRS may amount to CAD $607.10 [U.S. $614.06] per patient per year, within the context of a single-payer health care system. Managing clinicians should be aware of patient groups with a greater perceived financial burden and consider counseling them on strategies to offset expenses, including obtaining travel grants, using telemedicine for follow-up assessments, providing drug samples, and streamlining diagnostic testing with medical visits.

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