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| Content Provider | Springer Nature : BioMed Central |
|---|---|
| Author | Nandi, Sulakshana Schneider, Helen |
| Abstract | Background Universal health coverage (UHC) has provided the impetus for the introduction of publicly funded health insurance (PFHI) schemes in the mixed health systems of India and many other low- and middle-income countries. There is a need for a holistic understanding of the pathways of impact of PFHI schemes, including their role in promoting equity of access. Methods This paper applies an equity-oriented evaluation framework to assess the impacts of PFHI schemes in Chhattisgarh State by synthesising literature from various sources and highlighting knowledge gaps. Data were collected from an extensive review of publications on PFHI schemes in Chhattisgarh since 2009, including empirical studies from the first author’s PhD and grey literature such as programme evaluation reports, media articles and civil society campaign documents. The framework was constructed using concepts and frameworks from the health policy and systems research literature on UHC, access and health system building blocks, and is underpinned by the values of equity, human rights and the right to health. Results The analysis finds that evidence of equitable enrolment in Chhattisgarh’s PFHI scheme may mask many other inequities. Firstly, equitable enrolment does not automatically lead to the acceptability of the scheme for the poor or to equity in utilisation. Utilisation, especially in the private sector, is skewed towards the areas that have the least health and social need. Secondly, related to this, resource allocation patterns under PFHI deepen the ‘infrastructure inequality trap’, with resources being effectively transferred from tribal and vulnerable to ‘better-off’ areas and from the public to the private sector. Thirdly, PFHI fails in its fundamental objective of effective financial protection. Technological innovations, such as the biometric smart card and billing systems, have not provided the necessary safeguards nor led to greater accountability. Conclusion The study shows that development of PFHI schemes, within the context of wider neoliberal policies promoting private sector provisioning, has negative consequences for health equity and access. More research is needed on key knowledge gaps related to the impact of PFHI schemes on health systems. An over-reliance on and rapid expansion of PFHI schemes in India is unlikely to achieve UHC. |
| Related Links | https://health-policy-systems.biomedcentral.com/counter/pdf/10.1186/s12961-020-00555-3.pdf |
| Ending Page | 14 |
| Page Count | 14 |
| Starting Page | 1 |
| File Format | HTM / HTML |
| ISSN | 14784505 |
| DOI | 10.1186/s12961-020-00555-3 |
| Journal | Health Research Policy and Systems |
| Issue Number | 1 |
| Volume Number | 18 |
| Language | English |
| Publisher | BioMed Central |
| Publisher Date | 2020-05-25 |
| Access Restriction | Open |
| Subject Keyword | Health Administration R & D Technology Policy Medicine Public Health Health Services Research Health Policy Universal health coverage Publicly funded health insurance Equity Access HPSR India R & D/Technology Policy Medicine/Public Health |
| Content Type | Text |
| Resource Type | Article |
| Subject | Health Policy |
| Journal Impact Factor | 3.6/2023 |
| 5-Year Journal Impact Factor | 4.3/2023 |
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