ISSN (Print) - 0012-9976 | ISSN (Online) - 2349-8846

Health expenditureSubscribe to Health expenditure

Evaluating Health Insurance Programmes

An array of bottlenecks has ensured that the numerous health insurance schemes introduced over the years have failed to make any significant dent on the health sector. This article tries to assess these problems by using the “insurance cascade,” a framework that traces the steps from enrolling eligible households to ultimately delivering their benefits. The existing evidence suggests substantial bottlenecks across all cascade steps, with especially large gaps in beneficiaries’ awareness of how to enrol in schemes, what the schemes covers, and how to access scheme benefits.

Accumulation of Poor Health Infrastructure

India has to substantially scale up its health infrastructure to protect lives and livelihoods.

The Interstate Variation in Mortality from COVID-19 in India

While the response to COVID-19 by the Government of India has been more or less uniform across the country, in that a lockdown was imposed throughout, the death rate has varied across the states. This suggests that region-specific factors are likely to be relevant to the determination of this rate. A significant aspect of this study is the use of three different measures of the death rate in the empirical exercise. This showed all three measures of the death rate to be strongly related to health expenditure as a share of the gross domestic product but hardly at all to public health infrastructure. This can be interpreted as a sign of the role of the public health system—comprising medical personnel, infrastructure and protocols—in the prevention of death, with health expenditure as a key determinant of its effectiveness. It has an implication for public policy beyond the immediate health emergency due to COVID-19.

‘When You Start Doing This Work, It Is Hard to Eat Dal’

In 2013, manual scavenging, or the cleaning of “dry” latrines with unprotected hands, was abolished in India. Yet, millions of dry latrines are still manually serviced by Dalit labour. The Prime Minister’s Swachh Bharat Mission has put little effort into the health and dignity of sanitation workers relative to its efforts on subsidising and encouraging latrine-building. A few days spent with the Valmiki community in Lucknow are recounted.

Measuring Catastrophic Healthcare Expenditure

Catastrophic household healthcare expenditure is a prominent policy concern. The National Health Policy 2017 takes explicit cognisance of this issue and presents an empirical formulation to examine its incidence and patterns. However, the policy needs to account for household size variations to counter an implicit bias that tilts the estimates to reflect a higher concentration of catastrophic expenditure among the rich. This concern is illustrated using health data from the 71st round of the National Sample Survey. Further, a minor modification to unravel the socio-economic gradient in catastrophic healthcare expenditure has also been discussed.

Publicly Financed Health Insurance Schemes

The announcement of the National Health Protection Scheme provides us with an opportunity to see how its predecessor Rashtriya Swasthya Bima Yojana and other publicly funded health insurance schemes have fared so far. The experiences of PFHIS indicate that targeted health insurance coupled with a healthcare delivery system dominated by “for profit” private providers failed to address the issues of access and financial risk protection. They possibly displace resources that can be utilised for strengthening a public health system.

Road Traffic Accidents and Injuries in India

Road traffic fatalities constitute 16.6% of all deaths, making this the sixth leading cause of death in India, and a major contributor to socio-economic losses, the disability burden, and hospitalisation. An attempt to measure catastrophic levels of health expenditure on accidental injuries, road traffic accidents, and falls, finds that the burden of out-of-pocket expenditure is the highest for such injuries. The financial burden is particularly high for poorer households in rural areas, and those seeking treatment at private health facilities with no health insurance. Public health facilities for trauma care and health coverage for low-income groups could help these vulnerable households.

Publicly-Financed Health Insurance for the Poor

Evaluating the effectiveness of the "targeting" approach in the Rashtriya Swasthya Bima Yojana, the present study examines the determinants of enrolment, hospitalisation and financial protection for below the poverty line households using data from a large-scale survey conducted in Maharashtra in 2012-13. Almost 50% of BPL households were found to be non-poor and only 30% of them were aware about RSBY. More importantly, the effect of RSBY on catastrophic health expenditure was not found to be statistically significant. Since commercial insurance companies and their third party administrators have limited interest in awareness generation and enrolment, their role may be reviewed and instead an independent public agency should be given responsibility for enrolment of unorganised sector workers. This would be a key step towards achieving universal population coverage. However, in the long run, the government should strengthen the resource-starved public health system.
Back to Top