scholarly journals Utilisation and financial protection for hospital care under publicly funded health insurance in three states in Southern India

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Samir Garg ◽  
Sayantan Chowdhury ◽  
T. Sundararaman
Keyword(s):  
Health Insurance ◽  
Hospital Care ◽  
Tamil Nadu ◽  
Good Governance ◽  
National Sample ◽  
Southern India ◽  
Insurance Companies ◽  
Financial Protection ◽  
Publicly Funded ◽  
Insurance Cover

Abstract Background Many LMICs have implemented Publicly Funded Health Insurance (PFHI) programmes to improve access and financial protection. The national PFHI scheme implemented in India for a decade has been recently modified and expanded to cover free hospital care for 500 million persons. Since increase in annual cover amount is one of the main design modifications in the new programme, the relevant policy question is whether such design change can improve financial protection for hospital care. An evaluation of state-specific PFHI programmes with vertical cover larger than RSBY can help answer this question. Three states in Southern India - Andhra Pradesh, Karnataka and Tamil Nadu have been pioneers in implementing PFHI with a large insurance cover. Methods The current study was meant to evaluate the PFHI in above three states in improving utilisation of hospital services and financial protection against expenses of hospitalization. Two cross-sections from National Sample Survey’s health rounds, the 60th round done in 2004 and the 71st round done in 2014 were analysed. Instrumental Variable method was applied to address endogeneity or the selection problem in insurance. Results Enrollment under PFHI was not associated with increase in utilisation of hospital care in the three states. Private hospitals dominated the empanelment of facilities under PFHI as well as utilisation. Out of Pocket Expenditure and incidence of Catastrophic Health Expenditure did not decrease with enrollment under PFHI in the three states. The size of Out of Pocket Expenditure was significantly greater for utilisation in private sector, irrespective of insurance enrollment. Conclusion PFHI in the three states used substantially larger vertical cover than national scheme in 2014. The three states are known for their good governance. Yet, the PFHI programmes in all three states failed in fulfilling their fundamental purpose. Increasing vertical cover of PFHI and using either ‘Trusts’ or Insurance-companies as purchasers may not give desired results in absence of adequate regulation. The study raises doubts regarding effectiveness of contracting under PFHIs to influence provider-behavior in the Indian context. Further research is required to find solutions for addressing gaps that contribute to poor financial outcomes for patients under PFHI.

scholarly journals Performance of India’s national publicly funded health insurance scheme, Pradhan Mantri Jan Arogaya Yojana (PMJAY), in improving access and financial protection for hospital care: findings from household surveys in Chhattisgarh state

2020 ◽  
Author(s):  
Samir Garg ◽  
Kirtti Kumar Bebarta ◽  
Narayan Tripathi
Keyword(s):  
Health Insurance ◽  
Cross Sections ◽  
Hospital Care ◽  
National Sample ◽  
Catastrophic Health Expenditure ◽  
Sample Survey ◽  
Primary Data ◽  
Financial Protection ◽  
Health Coverage ◽  
Publicly Funded

Abstract Background:A national Publicly Funded Health Insurance (PFHI) scheme called Pradhan Mantri Jan Arogaya Yojana (PMJAY) was launched by government of India in 2018. PMJAY seeks to cover 500 million persons with an annual cover of around 7000 USD per household. PMJAY claims to be the largest government funded health scheme globally and has attracted an international debate as a policy for Universal Health Coverage. India’s decade-long experience of the earlier national and state-specific PFHI schemes had shown poor effectiveness in financial protection. Most states in India have completed a year of implementation of PMJAY but no evaluations are available of this important scheme.Methods:The study was designed to find out the effect of enrolment under PMJAY in improving utilisation of hospital services and financial protection in Chhattisgarh which has been a leading state in implementing PFHI in terms of enrolment and claims. The study analyses three repeated cross-sections. Two of the cross-sections are from National Sample Survey (NSS) health rounds – year 2004 when there was no PFHI and 2014 when the older PFHI scheme was in operation. Primary data was collected in 2019-end to cover the first year of PMJAY implementation and it formed the third cross-section. Multivariate analysis was carried out. In addition, Propensity Score Matching and Instrumental Variable method were applied to address the selection problem in insurance.Results:Enrollment under PMJAY or other PFHI schemes did not increase utilisation of hospital-care in Chhattisgarh. Out of Pocket Expenditure (OOPE) and incidence of Catastrophic Health Expenditure did not decrease with enrollment under PMJAY or other PFHI schemes. The size of OOPE was significantly greater for utilisation in private sector, irrespective of enrollment under PMJAY.Conclusion:PMJAY provided substantially larger vertical cover than earlier PFHI schemes in India but it has not been able to improve access or financial protection so far in the state. Though PMJAY is a relatively new scheme, the persistent failure of PFHI schemes over a decade raises doubts about suitability of publicly funded purchasing from private providers in the Indian context. Further research is recommended on such policies in LMIC contexts.

scholarly journals Why is women’s utilization of a publicly funded health insurance low?: a qualitative study in Tamil Nadu, India

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Rajalakshmi RamPrakash ◽  
Lakshmi Lingam
Keyword(s):  
Health Insurance ◽  
Universal Health Coverage ◽  
Inpatient Care ◽  
Tamil Nadu ◽  
Financial Protection ◽  
Health Coverage ◽  
Publicly Funded ◽  
Insurance Scheme ◽  
Gender Barriers ◽  
Universal Health

Abstract Background The continuing impetus for universal health coverage has given rise to publicly funded health insurance schemes in lower-middle income countries. However, there is insufficient understanding of how universal health coverage schemes impact gender equality and equity. This paper attempts to understand why utilization of a publicly funded health insurance scheme has been found to be lower among women compared to men in a southern Indian state. It aims to identify the gender barriers across various social institutions that thwart the policy objectives of providing financial protection and improved access to inpatient care for women. Methods A qualitative study on the Chief Minister’s Comprehensive Health Insurance Scheme was carried out in urban and rural impoverished localities in Tamil Nadu, a southern state in India. Thirty-three women and 16 men who had a recent history of hospitalization and 14 stakeholders were purposefully interviewed. Transcribed interviews were content analyzed based on Naila Kabeer’s Social Relations Framework using gender as an analytical category. Results While unpacking the navigation pathways of women to utilize publicly funded health insurance to access inpatient care, gender barriers are found operating at the household, community, and programmatic levels. Unpaid care work, financial dependence, mobility constraints, and gender norms emerged as the major gender-specific barriers arising from the household. Exclusions from insurance enrollment activities at the community level were mediated by a variety of social inequities. Market ideologies in insurance and health, combined with poor governance by State, resulted in out-of-pocket health expenditures, acute information asymmetry, selective availability of care, and poor acceptability. These gender barriers were found to be mediated by all four institutions—household, community, market, and State—resulting in lower utilization of the scheme by women. Conclusions Health policies which aim to provide financial protection and improve access to healthcare services need to address gender as a crucial social determinant. A gender-blind health insurance can not only leave many pre-existing gender barriers unaddressed but also accentuate others. This paper stresses that universal health coverage policy and programs need to have an explicit focus on gender and other social determinants to promote access and equity.

Comorbid Illness, Injuries and Health Insurance Subscription Among Self-Reported Mentally Disabled Subjects of Tamil Nadu, India

2018 ◽  
Vol 47 (4) ◽  
pp. 249-259
Author(s):  
A.M. Anusa ◽  
C. Ramasubramaniam ◽  
Thavarajah Rooban
Keyword(s):  
Health Insurance ◽  
Chronic Illness ◽  
Odds Ratio ◽  
Tamil Nadu ◽  
Statistical Significance ◽  
Treatment Seeking ◽  
Mentally Disabled ◽  
Insurance Cover ◽  
Seeking Behavior ◽  
The Impact

Background.—Mentally Disabled (MD) subjects often have multiple co-morbidities and also experience injuries, acute and chronic illness like the general population. Details of such episodes and the impact of health insurance have not been described for Tamil Nadu, an Indian state population. This manuscript intends to report on this experience. Materials and Method.—Secondary Data Analysis of District Level Household and Facility survey-4 (2012-13) were employed for this study. Comparison of MD with the normal population was performed. Demographic characteristics along with injury (in preceding year), acute illness (within past 15 days) and the experience of chronic illness (requiring treatment for 1 month), treatment seeking behavior and health insurance coverage formed the variables. Descriptive statistics, chi-square and odds ratio are presented. P≤0.005 was considered as statistical significance. Result.—Of the 179381 surveyed, 565(0.3%) had some form of MD and 169938 (94.7%) had no disabilities. The two groups varied in age, gender, and marital status. MD population had nearly 4 times the incidence of injury (P = 0.000) in the past 1 year, more commonly requiring in-patient treatment. Epilepsy was more common among individuals with MD with odds ratio of 7.159 [P = 0.015]. Health insurance cover and its influence on treatment seeking behavior are presented. Discussion.—The experience of injuries, acute and chronic illness by individuals with MD, to the best of our knowledge has been described for the first time in Tamil Nadu. Individuals with MD and without health insurance often do not take treatment. The absence of health insurance with the resulting increased cost of out-of-pocket expense for chronic illness may force them to neglect their health. These factors are discussed along with recommendations for policy makers.

scholarly journals Promotional Tools Employed by Medical Insurance Companies to Attract International University Students

2018 ◽  
Vol 10 (6) ◽  
pp. 191
Author(s):  
Faith Rudairo Chibvura ◽  
Darry Penceliah
Keyword(s):  
Health Insurance ◽  
International Students ◽  
University Students ◽  
South African ◽  
Market Share ◽  
Medical Insurance ◽  
Insurance Companies ◽  
The South ◽  
Insurance Cover ◽  
International University

The South African Immigration Act 19 of 2004 requires that all international students have proof of medical insurance cover for the academic year of study. The medical insurance cover must be from a registered provider with the South African Council for Medical Schemes. Some medical insurance companies provide gifts to students to gain a larger market share within the educational institutions. Health insurance products are very crucial in the lives of university students and therefore the students must be familiar with medical product benefits and exclusions. It seems that many students lack relevant knowledge of health insurance products. Students seem to have a perception that medical insurance products cover all healthcare expenses. Dissatisfied customers may tarnish the image of the respective medical insurance company and result in customers seeking alternate products. The purpose of this paper is to determine the influence of promotional tools in creating awareness amongst international university students’ selection of medical insurance products. The study was descriptive and quantitative in nature. Four hundred international students studying at two state universities in Durban, South Africa completed a structured questionnaire. The results indicate that the respondents are very sensitive to price and the majority of them are influenced by advertising and word of mouth. The results of the study indicated that medical insurance companies should consider the quality of service and price as being very important factors when designing a promotional mix. Awareness creation is the backbone of sales growth and market share.

scholarly journals Overview of publicly funded health insurance: Tamil Nadu model

2012 ◽  
Vol 37 (3) ◽  
pp. 194 ◽  
Author(s):  
TS Selvavinayagam ◽  
S Vijayakumar
Keyword(s):  
Health Insurance ◽  
Tamil Nadu ◽  
Publicly Funded

The Commissions Paid to Brokers for Fully Insured Health Insurance Plans

2020 ◽  
pp. 107755872098056
Author(s):  
Ge Bai ◽  
Angela Park ◽  
Yang Wang ◽  
Heidi N. Overton ◽  
William E. Bruhn ◽  
...  
Keyword(s):  
Health Insurance ◽  
National Sample ◽  
Geographic Region ◽  
Insurance Companies ◽  
Health Plans ◽  
Purchasing Decisions ◽  
Policy Makers ◽  
Full Sample ◽  
Pharmacy Benefit ◽  
Insurance Agents

Insurance agents and brokers play an important role in facilitating the contracting of fully insured health insurance and pharmacy benefit plans for U.S. employers. They are primarily compensated with a commission charged back to the plan. Using a national sample that covered 11.7 million employees enrolled in 33,689 health plans in 2017, we found that a plan’s commission (median: $178) was positively associated with a plan’s premium (coefficient: 0.01 for the full sample and 0.03 for small plans, p < .001) after controlling for the number of enrollees. The commission-to-premium ratio was greater for smaller plans and plans offered by nonmajor insurance companies, and varied by geographic region. Policy makers should consider improving transparency of the commission to facilitate employers making efficient broker contracting and plan purchasing decisions. The fee-based brokerage model has the potential to help employers and workers contain health care spending.

scholarly journals Promotional Tools Employed by Medical Insurance Companies to Attract International University Students

2018 ◽  
Vol 10 (6(J)) ◽  
pp. 191-200
Author(s):  
Faith Rudairo Chibvura ◽  
Darry Penceliah
Keyword(s):  
Health Insurance ◽  
International Students ◽  
University Students ◽  
South African ◽  
Market Share ◽  
Medical Insurance ◽  
Insurance Companies ◽  
The South ◽  
Insurance Cover ◽  
International University

The South African Immigration Act 19 of 2004 requires that all international students have proof of medical insurance cover for the academic year of study. The medical insurance cover must be from a registered provider with the South African Council for Medical Schemes. Some medical insurance companies provide gifts to students to gain a larger market share within the educational institutions. Health insurance products are very crucial in the lives of university students and therefore the students must be familiar with medical product benefits and exclusions. It seems that many students lack relevant knowledge of health insurance products. Students seem to have a perception that medical insurance products cover all healthcare expenses. Dissatisfied customers may tarnish the image of the respective medical insurance company and result in customers seeking alternate products. The purpose of this paper is to determine the influence of promotional tools in creating awareness amongst international university students’ selection of medical insurance products. The study was descriptive and quantitative in nature. Four hundred international students studying at two state universities in Durban, South Africa completed a structured questionnaire. The results indicate that the respondents are very sensitive to price and the majority of them are influenced by advertising and word of mouth. The results of the study indicated that medical insurance companies should consider the quality of service and price as being very important factors when designing a promotional mix. Awareness creation is the backbone of sales growth and market share.

scholarly journals Gender Inequity in Utilisation of Publicly Funded Health Insurance Schemes- Findings based on insurance data from a Southern Indian State

2021 ◽  
Vol 16 (3) ◽  
pp. 75-86
Author(s):  
Rajalakshmi RamPrakash ◽  
C. Joe Arun
Keyword(s):  
Health Insurance ◽  
Gender Equity ◽  
Tamil Nadu ◽  
Vulnerable Groups ◽  
Health Coverage ◽  
Publicly Funded ◽  
Gender Inequity ◽  
Comprehensive Health ◽  
Indian State ◽  
Total Claim

While Publicly Funded Health Insurance Schemes (PFHIS) can be an effective strategy to achieve Universal Health Coverage by offering financial protection, the extent to which they facilitate gender equity has been less explored. Women constitute one of the main vulnerable groups owing to a combination of health and economic vulnerabilities to access inpatient care services. Gender health equity requires that healthcare resources, such as PFHIS effectively reach women. This study investigates the gender differences in utilisation of Chief Ministers’ Comprehensive Health Insurance Scheme (CMCHIS) by looking at a large volume of claims data covering 2012 to 2014 in the southern Indian state, Tamil Nadu. Previous studies indicate that women in the state had a higher hospitalisation rate than men and are entitled equally to CMCHIS. By disaggregating the data on number of beneficiaries, claim status, average and total claim value, type of procedures based on gender on a random selection of 230265 cases, the paper points out that women’s utilization of CMCHIS is significantly lesser than men. Women constitute only 36% of all beneficiaries and received only half of the total claim value disbursed through the scheme. This pro-male bias was found to be statistically significant and consistent across the scheme years, age group and type of procedures. The study concludes that the gender inequity in utilization of CMCHIS is conspicuous and needs immediate attention from policy makers and administrators. With recent inclusion of COVID19 testing and treatment under PFHIS, the paper urges for further research lest more women are left behind.

scholarly journals A STUDY ON AWARENESS ON AB-PMJAY FOR TREATMENT OF DISEASES WITH SPECIAL REFERENCE TO CANCER CARE IN THANJAVUR DISTRICT OF TAMIL NADU

2021 ◽  
pp. 202-206
Author(s):  
Dr. V.Pugazhenthi
Keyword(s):  
Health Insurance ◽  
Low Income ◽  
Tamil Nadu ◽  
Central Government ◽  
Insurance Scheme ◽  
Total Period ◽  
Income Groups ◽  
Insurance Cover ◽  
Costly Treatment ◽  
Comprehensive Health

Ayushman Bharat or Modicare, the Central Government aims to provide a health insurance cover of Rs 5 lakh to 500 million Indians free of cost. This includes families from lower income groups that fall under the socio-economic caste census (SECC) data of 2011. PM-JAY envisions to help mitigate catastrophic expenditure on medical treatment which pushes nearly 6 crore Indians into poverty each year. In Tamil nadu a scheme called ‘Chief Minister Kalaignar’s Insurance Scheme for Life Saving Treatments’ (KHIS) was launched in the year 2009 to ensure that poor and low income groups who cannot afford costly treatment, are able to get free treatment in Government as well as private hospitals for serious ailments. Later this scheme was modified with extended coverage in the year 2011 and re-launched in the name of ‘Chief Minister’s Comprehensive Health Insurance Scheme (CMCHIS)’. Under this scheme, the sum assured for each is revised as Rs.1 lakh every year for a total period of four years and for a total value of Rs. 4 lakh. Now, a value addition is made to the exicting CMCHIS, after the launch of PM-JAY, providing an insurance cover upto Rs 5 lakh per family, per year for secondary and tertiary hospitalization

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