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

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Health Insurance in Private Hospitals

Private hospitals are expected to play a key role in the implementation of government-sponsored health insurance schemes in India. Examining the availability and spread of private hospitals in the country and an analysis of their empanelment in government-sponsored health insurance schemes reveal that in low-income states of the country, empanelment of private hospitals by insurance companies is low and concentrated in a few pockets. This may indicate differences in entry conditions or low willingness of private hospitals to participate in these schemes, which has implications for the access to healthcare and insurance for the poor.

Social and Systemic Determinants of Utilisation of Public Healthcare Services in Uttar Pradesh

Building on an earlier publication using the same data set plus case studies of three facilities, the reasons for the low utilisation of public health facilities in Uttar Pradesh despite the prohibitively high costs of care in the private sector are explored. The likelihood of choosing a public provider for hospitalisation care was 4.8 times higher in the poorest quintile and 3.4 times as high for women. Where access to public sector services is an issue, many go without any treatment and this could appear in the data to be a higher proportion of private sector utilisation. Inadequate facility density is one barrier to access. Facilities, which are by policy designed to offer very limited types of services—to collect user fees and prescribe drugs and diagnostics to be bought outside, and with no continuity of care between primary and secondary levels—lead to the diminishing of credibility of the public healthcare services. When services are available and there are incentives that facilitate access, like for childbirth, the choice shifts in favour of public services. Market-defined perceptions of what is good healthcare and an understaffed and demoralised workforce also contribute to poor utilisation.

Role of Government in Funded Health Insurance Schemes

State-funded health insurance schemes do not target the truly needy or completely miss them, while the government is unable to regulate the private sector. These aspects were not taken into account when the government announced the National Health Protection Scheme. The scheme will turn out to be just another means for the growth of the private sector in the secondary and tertiary care segments.

Abolishing User Fee and Private Wards in Public Hospitals

Abolition of any type of user fee and the decision to close private wards in hospitals run by the Delhi government may appear to be small steps. These measures are likely to reduce inequity in health services utilisation while signalling the government's intention to bring about changes for the better in health outcomes.
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