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 Impact of the Health Transformation Plan on the Number of Surgical Operations and Their Cancelation

2019 ◽  
Vol 56 ◽  
pp. 004695801984638
Author(s):  
MahmoodReza Miri Bonjar ◽  
Mohammad Khammarnia ◽  
Mahdie Bakhshi ◽  
Alireza Ansari-Moghaddam ◽  
Hassan Okati–Aliabad ◽  
...  
Keyword(s):  
Health Insurance ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Outpatient Service ◽  
Public Hospitals ◽  
Inpatient Service ◽  
Treatment Needs ◽  
Study Population ◽  
The Impact ◽  
Surgical Operations

Operation cancelations are a serious problem with undesirable consequences. The Health Transformation Plan was launched in the health system of Iran on May 5, 2014, to enhance the efficiency and quality of services in public hospitals. Comprehensive coverage of patients’ basic treatment needs and reduction of patients’ out-of-pocket expenditures through insurance for all are other objectives of Health Transformation Plan as well. Then, the present study aimed to determine the impact of the Health Transformation Plan on the number of surgical operations and the cancelation of elective surgeries within public hospitals of Iran. This retrospective comparative study was conducted in 2017 within 2 tertiary public hospitals in the South-East of Iran. Using systematic random sampling method and census, 8138 scheduled surgical files and all canceled operations files were reviewed from April 2012 to March 2017, respectively. A standard checklist was used for data collection. The data were analyzed using χ2 test and a logistic regression model in SPSS, version 21. The study population was 8138 patients with mean age of 33 ± 19 years. Female patients comprised about 51% of the study population (n = 4115), and nearly two-third of them were married (n = 5192 [63.79%]). Coverage by Iranian health insurance was reported in more than half of patients (n = 4415 [54.79%]). The common reason for surgeries was injury and poisoning (n = 2814 [34.52%]) followed by delivery (n = 1747 [21.46%]). The number of operations increased from 26 677 before Health Transformation Plan (cancelation rate = 1.5%) to 33 190 after Health Transformation Plan (cancelation rate = 2.0%). The cancelation rate had a significant relationship with age (odds ratio = 1.009; confidence interval: 1.00-1.01), health insurance status (odds ratio = 2.12; confidence interval: 1.33-3.38), outpatient service referrals (odds ratio = 0.5; confidence interval: 0.43-0.62), inpatient service referrals (odds ratio = 1.5; confidence interval: 1.36-1.77), and surgical types ( P < .05). In general, the Health Transformation Plan was markedly associated with a rise in the number of surgeries and cancelation rate in the public hospitals. The information obtained in the present study concerning the causes of operation cancelations can be used to decrease the number of future cancelations.

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 Synergy of policies to strengthen primary care: evidence from a national repeated cross-sectional study

2020 ◽  
Author(s):  
Yinzi Jin ◽  
Jin Xu ◽  
Weiming Zhu ◽  
Yaoguang Zhang ◽  
Ling Xu ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Insurance ◽  
Health Workforce ◽  
Healthcare Seeking ◽  
Percentage Points ◽  
Level Data ◽  
Seeking Behavior ◽  
Healthcare Seeking Behavior ◽  
Negative Impacts ◽  
The Impact

Abstract Background: People bypass primary healthcare (PHC) institutions to seek expensive healthcare at high-level hospitals, leading to escalating medical costs and inefficient use of resources. In 2009, China launched nationwide synergic policies on primary care strengthening, to tackle access to healthcare and financial protection. This study aimed to assess the impact of the two policy areas, health insurance and health workforce, on healthcare seeking behavior. Methods: Drawing on national survey data before (2008) and after (2013) the policies, we linked individual-level data on healthcare-seeking behavior with county-level data on health workforce and health insurance. We constructed a multilevel zero-inflated negative binomial regression to examine the impacts of average reimbursement rate (ARR) of health insurance and the density of registered physicians on outpatient/inpatient visits, and multilevel multinomial logistic regression for the impacts on choice of outpatient/inpatient care providers. Results : Although the increase in health insurance ARR and physician density have positive impacts on individuals’ healthcare use, their impacts might be weakened during 2008 and 2013, and the negative impacts of investment of those in PHC institutions on likelihood of visiting hospitals was larger. The negative impacts of ARR at PHC institutions on likelihood of visiting county-, municipal- and higher-level hospitals in 2013 was 28 percentage points, 66 percentage points and 33 percentage points larger than these in 2008. Conclusions: Primary care strengthening requires synergic policies. Effective mechanisms for coordination across multisectoral actions are necessities for deepening those policies to ensure efficient delivery of healthcare without experiencing financial risks.

scholarly journals Synergy of policies to strengthen primary care: evidence from a national repeated cross-sectional study

2020 ◽  
Author(s):  
Yinzi Jin ◽  
Jin Xu ◽  
Weiming Zhu ◽  
Yaoguang Zhang ◽  
Ling Xu ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Insurance ◽  
Health Workforce ◽  
Healthcare Seeking ◽  
Percentage Points ◽  
Level Data ◽  
Seeking Behavior ◽  
Healthcare Seeking Behavior ◽  
Negative Impacts ◽  
The Impact

Abstract Background: People bypass primary healthcare (PHC) institutions to seek expensive healthcare at high-level hospitals, leading to escalating medical costs and inefficient use of resources. In 2009, China launched nationwide synergic policies on primary care strengthening, to tackle access to healthcare and financial protection. This study aimed to assess the impact of the two policy areas, health insurance and health workforce, on healthcare seeking behavior.Methods: Drawing on national survey data before (2008) and after (2013) the policies, we linked individual-level data on healthcare-seeking behavior with county-level data on health workforce and health insurance. We constructed a multilevel zero-inflated negative binomial regression to examine the impacts of average reimbursement rate (ARR) of health insurance and the density of registered physicians on outpatient/inpatient visits, and multilevel multinomial logistic regression for the impacts on choice of outpatient/inpatient care providers. Results: Although the increase in health insurance ARR and physician density have positive impacts on individuals’ healthcare use, their impacts might be weakened during 2008 and 2013, and the negative impacts of investment of those in PHC institutions on likelihood of visiting hospitals was larger. The negative impacts of ARR at PHC institutions on likelihood of visiting county-, municipal- and higher-level hospitals in 2013 was 28 percentage points, 66 percentage points and 33 percentage points larger than these in 2008.Conclusions: Primary care strengthening requires synergic policies. Effective mechanisms for coordination across multisectoral actions are necessities for deepening those policies to ensure efficient delivery of healthcare without experiencing financial risks.

scholarly journals Distributional impact of recent changes in private health insurance policies

2005 ◽  
Vol 29 (2) ◽  
pp. 167 ◽  
Author(s):  
Agnes Walker ◽  
Richard Percival ◽  
Linc Thurecht ◽  
James Pearse
Keyword(s):  
Health Insurance ◽  
Private Health Insurance ◽  
Private Hospital ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
Income Groups ◽  
Insurance Cover ◽  
Coverage Model ◽  
Distributional Impact ◽  
The Impact

The impacts of changes to private health insurance (PHI) policies introduced since 1999 ? in particular the 30% PHI rebate and the Lifetime Health Cover ? have been much debated. We present historical analyses of the impacts in terms of the proportion of Australians having hospital insurance cover under different PHI policies, by age, gender and socioeconomic status, and project these to 2010 using a new Private Health Insurance coverage model. The combined effect of the 30% rebate and Lifetime Health Cover was to increase PHI membership from just over 30% in 1998 to just under 50% by the end of 2000, due mainly to more people taking out PHI cover from among the richest 20% of the population. Among the poorest 40% the impact was minimal. Model projections suggested that, had the new PHI policies not been introduced, then the proportion of Australians with PHI would have declined to around 20% by 2010, compared with 40% if the current arrangements remained in place. Also, analysis of 2001 survey data regarding choices to use a public or a private hospital indicated that higher income groups with or without PHI were the more likely to have used a private hospital than lower income groups. Among those with PHI, older people were more likely to have used a private hospital than younger ones.

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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