scholarly journals Financial Protection in Health Insurance Schemes: A Comparative Analysis of Mediclaim Policy and CHAT Scheme in India

2012 ◽  
Vol 14 (1) ◽  
pp. 13-25 ◽  
Author(s):  
Sukumar Vellakkal
Keyword(s):  
Health Insurance ◽  
Low Income ◽  
Private Health Insurance ◽  
Household Survey ◽  
Financial Protection ◽  
Health Plans ◽  
Total Health Expenditure ◽  
Hypothetical Situation ◽  
Resource Poor ◽  
Insurance Penetration

This article analyzes the level of financial protection to low-income people during illness in ‘private health insurance’ and ‘people’s preferred health insurance’. In a hypothetical situation of being insured with both the pro-poor version of the ‘Mediclaim policy’ (private health insurance) and CHAT—‘Choosing Health Plans All-Together’—scheme (people’s preferred health insurance), this study analyzed the out-of-pocket-spending for health care incurred by persons per reported illness episodes in four select resource-poor locations in India. Three data sources were used: (a) household survey, (b) CHAT: a field-based experiment conducted in India to reveal people’s preference for health insurance benefits and (c) the specification of conditions of Mediclaim policy. The study found, first, that the Mediclaim policy covers a small proportion (8 per cent) of the total reported illness episodes but CHAT scheme covers a large proportion (90 per cent) of illness episodes and, second, that the Mediclaim policy reimburses 5 per cent of the total health expenditure but CHAT scheme reimburses 37 per cent. The study concludes that private health insurance provides lower level of financial protection compared to ‘people’s preferred health insurance’ and hence recommends that health insurance packages must be comprehensive and reflect community preference to make it attractive so that health insurance penetration can be increased.

scholarly journals Public health insurance and birth outcomes: evidence from Punjab, Pakistan

2020 ◽  
Author(s):  
Najam uz Zehra Gardezi
Keyword(s):  
Public Health ◽  
Health Insurance ◽  
Low Income ◽  
Fixed Effects ◽  
Insurance Coverage ◽  
Birth Certificate ◽  
Household Survey ◽  
Public Health Insurance ◽  
Health Seeking ◽  
Cross Sectional

Abstract Public health insurance targeted towards low-income households has gained traction in many developing countries. However, there is limited evidence as to the effectiveness of these programs in countries where institutional constraints may limit participation by the eligible population. This paper evaluates a recent health insurance initiative introduced in Pakistan and discusses whether eligibility for the programme improves maternal health seeking behaviour. The Prime Minister National Health Program provides free insurance coverage to low-income families. The programme is in the early phases of implementation and has, since 2016, only been rolled out in a few eligible districts within the country. This allows for a comparison of eligible households in districts where the programme has been introduced to those that are eligible to receive insurance at a future date. Using repeated cross-sectional data from multiple rounds of representative household survey, a difference-in-difference model has been estimated. Results show that at least for a specific beneficiary group (i.e. pregnant women), there has been a positive increase in utilization of hospital services. Furthermore, we provide evidence using mother fixed effects that the programme increased the likelihood of a child’s birth being documented. Since possession of a birth certificate can secure civic rights for a child, this is an unintended but positive outcome of the programme.

scholarly journals Financial protection effects of private health insurance: experimental evidence from Chinese households with resident basic medical insurance

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Xian-zhi Fu
Keyword(s):  
Health Insurance ◽  
Financial Risk ◽  
Private Health Insurance ◽  
Insurance Coverage ◽  
Medical Insurance ◽  
Chinese Government ◽  
Marginal Effect ◽  
Financial Protection ◽  
Basic Medical Insurance ◽  
Basic Medical

Abstract Background After achieving universal basic medical insurance coverage, Chinese government put the development of private health insurance (PHI) on its agenda to further strengthen financial risk protection. This paper aims to assess the level of financial protection that PHI provides for its insured households on the basis of resident basic medical insurance (RBMI). Methods We employed balanced panel data collected between 2015 and 2017 from the China Household Finance Survey (CHFS). Catastrophic health expenditure (CHE) and impoverishment due to health spending were applied to measure the financial protection effects. Random effects panel logistic regression model was performed to identify the factors associated with CHE and impoverishment among households covered by RBMI. In the robustness test, the method of propensity score matching (PSM) was employed to solve the problem of endogeneity. Results From 2015 to 2017, the CHE incidence increased from 12.96 to 14.68 % for all sampled households, while the impoverishment rate decreased slightly from 5.43 to 5.32 % for all sampled households. In 2015, the CHE incidence and impoverishment rate under RBMI + PHI were 4.53 and 0.72 %, respectively, which were lower than those under RBMI alone. A similar phenomenon was observed in 2017. Regression analysis also showed that the households with RBMI + PHI were significantly less likely to experience CHE (marginal effect: -0.054, 95 %CI: -0.075 to -0.034) and impoverishment (marginal effect: -0.049, 95 %CI: -0.069 to -0.028) compared to those with RBMI alone. The results were still robust after using PSM method to eliminate the effects of self-selection on the estimation results. Conclusions In the context of universal basic medical insurance coverage, the CHE incidence and impoverishment rate of Chinese households with RBMI were still considerably high in 2015 and 2017. PHI played a positive role in decreasing household financial risk on the basis of RBMI.

The Incidence of Health Shocks, Formal Health Insurance, and Informal Coping Mechanisms

2016 ◽  
Vol 15 (6) ◽  
pp. 665-695
Author(s):  
Samuel Amponsah
Keyword(s):  
Developing Countries ◽  
Health Insurance ◽  
Low Income ◽  
Insurance Coverage ◽  
Household Survey ◽  
Health Insurance Coverage ◽  
Coping Mechanisms ◽  
Health Shocks ◽  
Economics Of Health ◽  
The Impact

In recent years, both theoretical and empirical research has accumulated in development economics literature regarding household behavior in response to shocks in developing countries. The literature especially has explored deeply the impact of weather-related shocks—such as droughts and floods—and the efficiency of informal mechanisms to cope with these shocks. In sharp contrast, our knowledge on the economics of health shocks in low-income developing countries is rather limited. A few studies have documented that low incomes and poor health insurance coverage account for catastrophic medical expenditures in the event of a health shock. This study uses a combination of Ghanaian household survey datasets to examine the different coping mechanisms employed by uninsured households to protect themselves from the incidence of health shocks. In addition, it explores the impact of formal health insurance (the National Health Insurance Scheme) on households’ out-of-pocket spending and catastrophic health expenditures.

scholarly journals Health Insurance is Dead; Long Live Health Insurance

2014 ◽  
Vol 40 (2-3) ◽  
pp. 195-214 ◽  
Author(s):  
Wendy K. Mariner
Keyword(s):  
Health Insurance ◽  
Private Health Insurance ◽  
Health Plans ◽  
Public And Private ◽  
Department Of Labor ◽  
Department Of Health ◽  
Patient Protection ◽  
Old Order ◽  
Private Employer ◽  
Treasury Department

Upon the death of a king or queen, the proclamation “the king is dead, long live the king” announces a new monarch’s accession to the throne, preserving the sovereign order. As the Patient Protection and Affordable Care Act (ACA) is implemented, it is tempting to proclaim the reign of a new system of health insurance. But, will it preserve the old order or initiate a new form of governance? As states and insurers grapple with new rules and regulations being issued from the Department of Health and Human Services, the Treasury Department and the Department of Labor, one might believe an entirely new health insurance system is being built. Yet, the ACA is designed to preserve existing forms of public and private health insurance, such as Medicare and private employer group health plans, which will continue to operate much as they have in the recent past. What has changed is the role that insurance will play and how that will shape the way we think about health policy.

Consumer Health Insurance Shopping Behavior and Challenges: Lessons From Two State-Based Marketplaces

2017 ◽  
Vol 76 (4) ◽  
pp. 403-424 ◽  
Author(s):  
Anna D. Sinaiko ◽  
Jon Kingsdale ◽  
Alison A. Galbraith
Keyword(s):  
Health Insurance ◽  
Health Plan ◽  
Low Income ◽  
Unmet Need ◽  
Shopping Behavior ◽  
Health Plans ◽  
Consumer Health ◽  
Early Experiences ◽  
Plan Choice ◽  
Fair Poor

Selecting a health plan in a health insurance exchange is a critical decision, yet consumers are known to face challenges with health plan choice. We surveyed new enrollees in two state-based exchanges in 2015 to investigate how a nonelderly, primarily low-income population chose their health plans and the implications of shopping behavior for early experiences in their plans. Financial considerations were most important to enrollees. Prior Medicaid enrollees and the uninsured were more likely to have multiple shopping challenges (e.g., difficulty identifying the best or most affordable plan, fair/poor experience, unmet need for help) than enrollees with prior employer coverage (42.9% vs. 32.5% vs. 16.4%, respectively, p < .01). Shopping challenges were associated with difficulty finding a doctor, understanding coverage, and getting questions answered. Assistance targeting enrollees who previously had Medicaid or lacked insurance could improve both shopping experiences and downstream outcomes in plans.

Financial risk protection of individuals with private health insurance

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
M Blümel ◽  
K Achstetter ◽  
J Köppen ◽  
R Busse
Keyword(s):  
Health Insurance ◽  
Household Income ◽  
Private Health Insurance ◽  
Unmet Needs ◽  
Financial Burden ◽  
Financial Protection ◽  
Lower Income ◽  
Financial Barriers ◽  
Catastrophic Expenditures ◽  
Privately Insured

Abstract Background Financial Protection is a key dimension of universal health coverage and health system performance assessment and is also monitored within the framework of the sustainable development goals. Analyses of financial hardship among people who have out-of-pocket (OOP) spending through the use of health services in Germany usually focus solely on households with statutory health insurance due to the peculiarities of private health insurance (PHI) data. This study aims to analyse financial protection among privately insured in Germany. Methods A cross-sectional survey was conducted in 2018 with 20,000 privately insured in Germany. The survey comprised questions on household net-income, OOP spending on health, unmet needs, perceived financial burden). Catastrophic expenditure was analysed and defined as share of households with OOP spending greater than 10% of household income. Further results on financial protection and access are based on descriptive analyses. Results A total of 3,601 participants (18.0%) completed the survey (58.6 years ± 14.6; 64.6% male). 82.2% of households reported OOP spending, mostly on OTC drugs, deductibles and medical aids. Median OOP spending was €300-499 per year. Average OOP spending as share of household income was 1.3% and 0.6% of households have catastrophic OOP spending. In total, 6.6% of respondents reported unmet needs due to financial barriers, of which 5.3% had no OOP spending. 11.2% of all respondents reported to feel strongly financially burdened by OOP spending with a gap between the lowest (26.2%) and highest income group (9.9%). Conclusions PHI insured have comparatively low OOP spending with less than 1% of households having catastrophic expenditures on health. However, 6.2% of respondents reported to forgo care due to financial reasons which supports the assumption that OOP payments can create a barrier to access. Unmet needs and financial burden are higher in lower income groups which raises concerns about equity. Key messages Financial protection is good among privately insured in Germany with only few households reporting catastrophic expenditures which indicates a broad and sufficient benefit coverage under PHI. Although out-of-pocket spending is low, privately insured perceive a strong financial burden (particularly in lower income groups) and face financial barriers to access care mirrored in forgone care.

scholarly journals Comparison of Utilization, Costs, and Quality of Medicaid vs Subsidized Private Health Insurance for Low-Income Adults

2021 ◽  
Vol 4 (1) ◽  
pp. e2032669
Author(s):  
Heidi Allen ◽  
Sarah H. Gordon ◽  
Dennis Lee ◽  
Aditi Bhanja ◽  
Benjamin D. Sommers
Keyword(s):  
Health Insurance ◽  
Low Income ◽  
Private Health Insurance
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