Abstract
Background: Janani Suraksha Yojana (JSY), a conditional cash transfer program in India, incentivized women to deliver at institutions and resulted in a significant increase in institutional births. Another major health policy reform, which could have influenced maternal and child health care (MCH) utilisation, was the public health insurance scheme called Rashtriya Swasthya Bima Yojana (RSBY) launched in 2008. However, there is lack of evidence on how RSBY impacted MCH utilisation in India. This study investigated the impact of health insurance (in particular, the public insurance scheme versus private insurance) on a continuum of MCH utilisation. We also investigated whether maternal empowerment was a significant correlate that affects MCH utilisation. Methods: The study used a multilevel mixed effect ordered logistic regression modelling, using a cohort of mothers whose delivery was captured in both the 2005 and 2011/12 rounds of the Indian Human Development Survey (IHDS). We derived indexes for women’s empowerment using Principal component analysis (PCA) technique applied to various indicators of women’s autonomy and socio-economic status. Results: Our results indicated, mothers’ MCH utilization levels vary by district, community and mother over time. The effect of the public insurance scheme (RSBY) on MCH utilisation was not as strong as privately available insurance. However, health insurance was only significant in models that did not control for household and mother level predictors. Our findings indicated that maternal empowerment indicators – in particular, maternal ability to go out of the house and complete chores and economic empowerment - were associated with higher utilization of MCH services. Among control variables, maternal age, education and household wealth were significant correlates that increase MCH service utilization over time. Conclusions: Change in women’s and societal attitude towards maternal care may have played a significant role in increasing MCH utilisation over the study period. There might be a need to increase the coverage of the public insurance scheme given the finding that it was less effective in increasing MCH utilisation. Importantly, policies that aim to improve health services for women need to take maternal autonomy and empowerment into consideration.
Measuring the Impact of Outreach and Enrollment Strategies for Public Health Insurance in California
