Journal Article

Effect of health insurance program for the poor on out-of-pocket inpatient care cost in India: evidence from a nationally representative cross-sectional survey

Khan, M. Mahmud, Sriram, Shyamkumar

2020

Overview

Background In India, Out-of-pocket expenses accounts for about 62.6% of total health expenditure - one of the highest in the world. Lack of health insurance coverage and inadequate coverage are important reasons for high out-of-pocket health expenditures. There are many Public Health Insurance Programs offered by the Government that cover the cost of hospitalization for the people below poverty line (BPL), but their coverage is still not complete. The objective of this research is to examine the effect of Public Health Insurance Programs for the Poor on hospitalizations and inpatient Out-of-Pocket costs. Methods Data from the recent national survey by the National Sample Survey Organization, Social Consumption in Health 2014 are used. Propensity score matching was used to identify comparable non-enrolled individuals for individuals enrolled in health insurance programs. Binary logistic regression model, Tobit model, and a Two-part model were used to study the effects of enrolment under Public Health Insurance Programs for the Poor on the incidence of hospitalizations, length of hospitalization, and Out-of- Pocket payments for inpatient care. Results There were 64,270 BPL people in the sample. Individuals enrolled in health insurance for the poor have 1.21 higher odds of incidence of hospitalization compared to matched poor individuals without the health insurance coverage. Enrollment under the poor people health insurance program did not have any effect on length of hospitalization and inpatient Out-of-Pocket health expenditures. Logistic regression model showed that chronic illness, household size, and age of the individual had significant effects on hospitalization incidence. Tobit model results showed that individuals who had chronic illnesses and belonging to other backward social group had significant effects on hospital length of stay. Tobit model showed that days of hospital stay, education and age of patient, using a private hospital for treatment, admission in a paying ward, and having some specific comorbidities had significant positive effect on out-of-pocket costs. Conclusions Enrolment in the public health insurance programs for the poor increased the utilization of inpatient health care. Health insurance coverage should be expanded to cover outpatient services to discourage overutilization of inpatient services. To reduce out-of-pocket costs, insurance needs to cover all family members rather than restricting coverage to a specific maximum defined.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Adult / Care and treatment / Cross-Sectional Studies / Enrollments / Female / Financial protection / governance and law / Health Administration / Health care access / Health care expenditures / Health care policy / Health Expenditures - statistics & numerical data / Health Informatics / Health insurance / Health policy / Health services / Health services utilization / Hospitalization / Hospitalization - economics / Hospitals / Hospitals, Private - economics / Households / Humans / India / Influence / Inpatient / Inpatient care / Inpatients - statistics & numerical data / Insurance / Insurance coverage / Insurance, Health - economics / Male / Medicine / Medicine & Public Health / Middle Aged / National health insurance / Nursing Research / Out of pocket costs / Out-of-pocket expenses / Out-of-pocket health expenditure / Poor / Population / Primary care / Public Health / reform / Research Article / Surveys / Uninsured people / Young Adult