Impact of Health Insurance on Accessibility, Utilization of Inpatient Care, and Financial Risk Protection Across States/Union Territories of India

Abstract

Background

Several health insurance programmes have been launched in India to improve accessibility to healthcare services and safeguard people against health expenditure catastrophes.

Objective

We studied the impact of health insurance enrolment towards accessibility, utilization of inpatient care, and safeguarding against financial risk across all states/union territories (UTs) of India.

Data and Methodology

Data from the most recent round (75th round) of the nationally representative survey on health and morbidity, entitled “Social Consumption: Health,” was employed in the study. The propensity score matching technique was used in the study to examine the accessibility and utilization of inpatient care, and financial risk protection in the context of health insurance across states/UTs of India.

Results

The accessibility to inpatient care was statistically significantly higher among insured than uninsured in 21/32 states/UTs (p < 0.05). Hospitalization episodes more than once were also statistically significantly higher among insured than uninsured (p < 0.05). However, utilization pattern of inpatient care in terms of incidence of hospitalization with private healthcare providers and longer duration of hospital stay were not impacted much by the health insurance status. Furthermore, health insurance was statistically significantly effective in reducing both out-of-pocket health expenditure (OOPE) and catastrophic health expenditure (CHE) (at 10% threshold) for insured in a few states, namely, Assam, Uttar Pradesh, Karnataka, Maharashtra, Delhi, Punjab, Tamil Nadu, Kerala, Meghalaya, Andhra Pradesh, and Telangana (p < 0.05). On the other hand, in some states with good health insurance enrolment rates, including Rajasthan, Chandigarh, Goa, and Chhattisgarh, health insurance did not significantly reduce the OOPE and CHE incidence among insured in comparison to uninsured (p > 0.05).

Policy Implications

Concerted efforts, such as increasing health insurance enrolment, raising awareness about the existing schemes and their eligibility criteria, and informing beneficiaries about the procedures to avail benefits, are required. There is also an urgent need to include outpatient services under the purview of health insurance to reduce the financial burden and make health insurance more viable. Furthermore, strengthening public healthcare facilities and regulating private healthcare providers are imperative in augmenting financial risk protection in India.