We aimed to compare the sociodemographics, health care utilization pattern, and out-of-pocket (OOP) expenses of 149 insured and 147 uninsured below-poverty-line households insured under the Comprehensive Health Insurance Scheme, Kerala, through a comparative cross-sectional study. Family size more than 4 (odds ratio [OR] = 2.34; 95% confidence interval [CI] = 1.13-4.82), family member with chronic disease (OR = 2.05; 95% CI = 1.18-3.57), high socioeconomic status (OR = 2.95; 95% CI = 1.74-5.03), and an employed household head (OR = 2.69; 95% CI = 1.44-5.02) were significantly associated with insured households. Insured households had higher inpatient service utilization (OR = 1.57; 95% CI = 1.05-2.34). Only 40% of inpatient service utilization among the insured was covered by insurance. The mean OOP expenses for inpatient services among insured (INR 448.95) was higher than among uninsured households (INR 159.93); P = .003. These findings show that urgent attention of the government is required to redesign and closely monitor the scheme.
International Labor Organization. Social Health Protection: An ILO Strategy Towards Universal Access to Health Care. Geneva, Switzerland: ILO; 2008.
2.
World Health Organization. World Health Report 2010. Health Systems Financing: The Path to Universal Coverage. Geneva, Switzerland: World Health Organization; 2010. http://www.who.int/whr/2010/en/. Accessed January 11, 2014.
CarrinGXuKEvansDB. Exploring the features of universal coverage. Bull World Health Organ. 2008;86:818.
6.
CarrinGJamesCEvansDB. Achieving Universal Health Coverage: Developing the Health Financing System. Geneva, Switzerland: World Health Organization; 2005.
7.
AkinJBirdsallNde Ferranti. Financing Health Services in Developing Countries: An Agenda for Reform. A World Bank Policy Study. Washington, DC: World Bank; 1987.
8.
Scheil-AdlungXJuettingJXuK. What Is the Impact of Social Health Protection on Access to Health Care, Health Expenditure and Impoverishment? A Comparative Analysis of Three African Countries. Geneva, Switzerland: World Health Organization; 2006. http://www.who.int/health_financing/documents/dp_e_06_2-access_africa.pdf. Accessed January 2, 2014.
9.
Ministry of Health and Family Welfare. National Health Policy 2002. New Delhi, India: Government of India; 2002.
10.
AhujaR. Health Insurance for the Poor in India. New Delhi, India: Indian Council for Research on International Economic Relations; 2004. Working Paper 123.
11.
RaoMRamachandraSSBandyopadhyayS. Addressing healthcare needs of people living below the poverty line: a rapid assessment of the Andhra Pradesh Health Insurance Scheme. Natl Med J India. 2011;24:335-341.
AroraDNanadaL. Towards alternative health financing: the experience of RSBY in Kerala. http://www.rsby.gov.in/documents.aspx?ID=14. Accessed January 29, 2014. RSBY Working Paper #4.
14.
Ministry of Health and Family Welfare. Draft National Health Policy 2015. New Delhi, India: Government of India; 2015.
15.
JowettMDeolalikarAMartinssonP. Health insurance and treatment seeking behaviour: evidence from a low-income country. Health Econ. 2004;13:845-857.
16.
WagstaffAPradhanM. Health Insurance Impacts on Health and Nonmedical Consumption in a Developing Country. Washington, DC: World Bank; 2005.
17.
BerkhoutEOostinghH. Health Insurance in Low-Income Countries: Where Is the Evidence That It Works?Oxford, UK: Oxfam International; 2008. Joint NGO Briefing Paper. http://www.oxfam.org/en/policy/bp112_health_insurance_0805. Accessed December 12, 2013.
18.
SpaanEMathijssenJTrompNMcBainFten HaveABaltussenR. The impact of health insurance in Africa and Asia: a systematic review. Bull World Health Organ. 2012;90:685A-692A. http://www.who.int/bulletin/volumes/90/9/12-102301.pdf. Accessed November 4, 2013.
19.
SepehriASarmaSSimpsonW. Does non-profit health insurance reduce financial burden? Evidence from the Vietnam Living Standards Survey Panel. Health Econ. 2006;15:603-616.
20.
PanopouluGVelezC. Subsidized Health Insurance, Proxy Means Testing and the Demand for Health Care Among the Poor in Colombia: Colombia Poverty Report Volume II. Washington, DC: World Bank; 2001.
21.
WagstaffA. Health Insurance for the Underprivileged: Initial Impacts of Vietnam’s Health Care Fund for the Poor. Washington, DC: World Bank; 2006.
22.
KnaulFMArreola-OrnelasHMéndez-CarniadoO. Evidence is good for your health system: policy reform to remedy catastrophic and impoverishing health spending in Mexico. Lancet. 2006;368:1828-1841.
KwonS. Health care financing in Asia: key issues and challenges. Asia Pac J Public Health. 2011;23:651-661.
25.
HsiehVC-RWuJCWuT-NChiangT. Universal coverage for primary health care is a wise investment: evidence from 102 low- and middle-income countries. Asia Pac J Public Health. 2015;27:NP877-886.
