NDLI: Effectiveness of government strategies for financial protection against costs of hospitalization Care in India

Content Provider	Springer Nature : BioMed Central
Author	Ranjan, Alok Dixit, Priyanka Mukhopadhyay, Indranil Thiagarajan, Sundararaman
Abstract	Background In the past decade, India has seen the introduction of many ‘publicly funded health insurance’ schemes (PFHIs) that claim to cover approximately 300 million people and are essentially forms of purchasing care from both public and private providers to reduce out-of-pocket expenditure (OOPE) for hospitalization. Methods Data from a recent government-organized nationwide household survey, The National Sample Survey 71st Round, were used to analyse the effectiveness and equity of tax-funded public health services and PFHIs as distinct but overlapping approaches to financial protection for hospitalization across different socio-economic categories. Cross-tabulation analysis, multivariate logistic regression and propensity score matching were the main analytical methods used. Results Government hospitals provide access to 45.6% of all hospitalization needs. Although poorer quintiles use public hospitals more often, even in the poorest quintile, as many as 37.2% are utilizing private hospitals. The average OOPE that a household experiences for hospitalization in public hospitals is approximately only one-fifth of the OOPE for hospitalization in the private sector. PFHI schemes cover 12.8% of the population, and coverage is higher in upper quintiles and in urban areas. Hospitalization rates increase with PFHI coverage, and this occurs with both public and private providers. Propensity score matching shows that PFHI contributes to a marginal reduction (1%) in ‘catastrophic health expenditure incidence at the 25% threshold’ (CHE-25) for the bottom three quintiles. The reported coverage of PFHIs was greater in the upper income quintiles. Utilization of public services was greater in the poorer income quintiles and more marginalized social groups. Conclusions Periodic surveys are essential to guide policy choices regarding the appropriate mix of strategies for financial protection in pluralistic systems. There is a need for caution regarding any shift in the role of governments from providing services to purchasing care, given the contexts and limitations of currently available PFHIs. Even with tax-funded public services, although the average OOPE is lower than the care purchased through PFHIs, there is still a modest level of CHE and impoverishment due to health care costs that persist. Both strategies need to be synergized for more effective financial protection.
Related Links	https://bmcpublichealth.biomedcentral.com/counter/pdf/10.1186/s12889-018-5431-8.pdf
Ending Page	12
Page Count	12
Starting Page	1
File Format	HTM / HTML
ISSN	14712458
DOI	10.1186/s12889-018-5431-8
Journal	BMC Public Health
Issue Number	1
Volume Number	18
Language	English
Publisher	BioMed Central
Publisher Date	2018-04-16
Access Restriction	Open
Subject Keyword	Public Health Medicine Epidemiology Biostatistics Vaccine Environmental Health Universal health coverage (UHC) Public funded health insurance (PFHI) Out-of-pocket expenditure (OOPE) Catastrophic health expenditure (CHE) Medicine/Public Health
Content Type	Text
Resource Type	Article
Subject	Public Health, Environmental and Occupational Health
Journal Impact Factor	3.5/2023
5-Year Journal Impact Factor	3.9/2023

Sl.	Authority	Responsibilities	Communication Details
1	Ministry of Education (GoI), Department of Higher Education	Sanctioning Authority	https://www.education.gov.in/ict-initiatives
2	Indian Institute of Technology Kharagpur	Host Institute of the Project: The host institute of the project is responsible for providing infrastructure support and hosting the project	https://www.iitkgp.ac.in
3	National Digital Library of India Office, Indian Institute of Technology Kharagpur	The administrative and infrastructural headquarters of the project	Dr. B. Sutradhar bsutra@ndl.gov.in
4	Project PI / Joint PI	Principal Investigator and Joint Principal Investigators of the project	Dr. B. Sutradhar bsutra@ndl.gov.in Prof. Saswat Chakrabarti will be added soon
5	Website/Portal (Helpdesk)	Queries regarding NDLI and its services	support@ndl.gov.in
6	Contents and Copyright Issues	Queries related to content curation and copyright issues	content@ndl.gov.in
7	National Digital Library of India Club (NDLI Club)	Queries related to NDLI Club formation, support, user awareness program, seminar/symposium, collaboration, social media, promotion, and outreach	clubsupport@ndl.gov.in
8	Digital Preservation Centre (DPC)	Assistance with digitizing and archiving copyright-free printed books	dpc@ndl.gov.in
9	IDR Setup or Support	Queries related to establishment and support of Institutional Digital Repository (IDR) and IDR workshops	idr@ndl.gov.in

Developing Malawi's Universal Health Coverage Index

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

The financial burden of out of pocket payments on medicines among households in Ethiopia: analysis of trends and contributing factors

Role of publicly funded health insurance in financial protection of the elderly from hospitalisation expenditure in India-findings from the longitudinal aging study

Lessons for Developing Countries From Outlier Country Health Systems

Out-of-Pocket Payments, Catastrophic Health Expenditure and Poverty Among Households in Nigeria 2010

Pathways to catastrophic health expenditure for acute coronary syndrome in Kerala: ‘Good health at low cost’?

Health insurance coverage and its impact on out-of-pocket expenditures at a public sector hospital in Kerala, India

Do poor people in the poorer states pay more for healthcare in India?

Effectiveness of government strategies for financial protection against costs of hospitalization Care in India

Similar Documents

Developing Malawi's Universal Health Coverage Index

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

The financial burden of out of pocket payments on medicines among households in Ethiopia: analysis of trends and contributing factors

Role of publicly funded health insurance in financial protection of the elderly from hospitalisation expenditure in India-findings from the longitudinal aging study

Lessons for Developing Countries From Outlier Country Health Systems

Out-of-Pocket Payments, Catastrophic Health Expenditure and Poverty Among Households in Nigeria 2010

Pathways to catastrophic health expenditure for acute coronary syndrome in Kerala: ‘Good health at low cost’?

Health insurance coverage and its impact on out-of-pocket expenditures at a public sector hospital in Kerala, India

Do poor people in the poorer states pay more for healthcare in India?

Effectiveness of government strategies for financial protection against costs of hospitalization Care in India