TY - JOUR
T1 - Impact of public-funded health insurances in India on health care utilisation and financial risk protection
T2 - A systematic review
AU - Reshmi, Bhageerathy
AU - Unnikrishnan, Bhaskaran
AU - Rajwar, Eti
AU - Parsekar, Shradha S.
AU - Vijayamma, Ratheebhai
AU - Venkatesh, Bhumika Tumkur
N1 - Funding Information:
in India. These schemes are funded by the central government, viz., RSBY, CGHS, Employee State Insurance Scheme, Swavlamban, Nirmaya-Disability Health Insurance Scheme and PMJAY and by the state governments like VAS (Karnataka), Rajiv Arogya Shree (Andhra Pradesh) and CHIS (Tamil Nadu). The eligibility criteria and benefits offered under each scheme vary according to different state governments. More information on these PFHI schemes is given in box 1.
Funding Information:
6. Employee State insurance Scheme—Employee State Insurance Scheme(1952), this scheme is funded by the employers and staff contributions and is applicable to employees of factories and es-tablishments drawing wages upto INR 15 000 a month. Under this scheme, a number of benefits to protect the employees or work-ers from illness, disability and death are paid to the beneficiaries. Benefits such as sickness benefit (70% of wages), temporary dis-ablement benefit (90% of last wage), permanent disability benefit (90% of wage), maternity benefit (100% of wage), dependent ben-efit (90% of wage), INR 10000 to dependents for funeral expenses in case of death of the employees and other benefits like vocational and physical rehabilitation are given to the beneficiaries.
Publisher Copyright:
© 2022 BMJ Publishing Group. All rights reserved.
PY - 2021/12/1
Y1 - 2021/12/1
N2 - Objective Universal Health Coverage aims to address the challenges posed by healthcare inequalities and inequities by increasing the accessibility and affordability of healthcare for the entire population. This review provides information related to impact of public-funded health insurance (PFHI) on financial risk protection and utilisation of healthcare. Design Systematic review. Data sources Medline (via PubMed, Web of Science), Scopus, Social Science Research Network and 3ie impact evaluation repository were searched from their inception until 15 July 2020, for English-language publications. Eligibility criteria Studies giving information about the different PFHI in India, irrespective of population groups (above 18 years), were included. Cross-sectional studies with comparison, impact evaluations, difference-in-difference design based on before and after implementation of the scheme, pre-post, experimental trials and quasi-randomised trials were eligible for inclusion. Data extraction and synthesis Data extraction was performed by three reviewers independently. Due to heterogeneity in population and study design, statistical pooling was not possible; therefore, narrative synthesis was performed. Outcomes Utilisation of healthcare, willingness-to-pay (WTP), out-of-pocket expenditure (including outpatient and inpatient), catastrophic health expenditure and impoverishment. Results The impact of PFHI on financial risk protection reports no conclusive evidence to suggest that the schemes had any impact on financial protection. The impact of PFHIs such as Rashtriya Swasthy Bima Yojana, Vajpayee Arogyashree and Pradhan Mantri Jan Arogya Yojana showed increased access and utilisation of healthcare services. There is a lack of evidence to conclude on WTP an additional amount to the existing monthly financial contribution. Conclusion Different central and state PFHIs increased the utilisation of healthcare services by the beneficiaries, but there was no conclusive evidence for reduction in financial risk protection of the beneficiaries. Registration Not registered.
AB - Objective Universal Health Coverage aims to address the challenges posed by healthcare inequalities and inequities by increasing the accessibility and affordability of healthcare for the entire population. This review provides information related to impact of public-funded health insurance (PFHI) on financial risk protection and utilisation of healthcare. Design Systematic review. Data sources Medline (via PubMed, Web of Science), Scopus, Social Science Research Network and 3ie impact evaluation repository were searched from their inception until 15 July 2020, for English-language publications. Eligibility criteria Studies giving information about the different PFHI in India, irrespective of population groups (above 18 years), were included. Cross-sectional studies with comparison, impact evaluations, difference-in-difference design based on before and after implementation of the scheme, pre-post, experimental trials and quasi-randomised trials were eligible for inclusion. Data extraction and synthesis Data extraction was performed by three reviewers independently. Due to heterogeneity in population and study design, statistical pooling was not possible; therefore, narrative synthesis was performed. Outcomes Utilisation of healthcare, willingness-to-pay (WTP), out-of-pocket expenditure (including outpatient and inpatient), catastrophic health expenditure and impoverishment. Results The impact of PFHI on financial risk protection reports no conclusive evidence to suggest that the schemes had any impact on financial protection. The impact of PFHIs such as Rashtriya Swasthy Bima Yojana, Vajpayee Arogyashree and Pradhan Mantri Jan Arogya Yojana showed increased access and utilisation of healthcare services. There is a lack of evidence to conclude on WTP an additional amount to the existing monthly financial contribution. Conclusion Different central and state PFHIs increased the utilisation of healthcare services by the beneficiaries, but there was no conclusive evidence for reduction in financial risk protection of the beneficiaries. Registration Not registered.
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U2 - 10.1136/bmjopen-2021-050077
DO - 10.1136/bmjopen-2021-050077
M3 - Article
AN - SCOPUS:85122314113
VL - 11
JO - BMJ Open
JF - BMJ Open
SN - 2044-6055
IS - 12
M1 - e050077
ER -