Cargando…
Impact of community-based health insurance in rural India on self-medication & financial protection of the insured
BACKGROUND & OBJECTIVES: The evidence-base of the impact of community-based health insurance (CBHI) on access to healthcare and financial protection in India is weak. We investigated the impact of CBHI in rural Uttar Pradesh and Bihar States of India on insured households’ self-medication and fi...
Autores principales: | , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Medknow Publications & Media Pvt Ltd
2016
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5094122/ https://www.ncbi.nlm.nih.gov/pubmed/27748307 http://dx.doi.org/10.4103/0971-5916.192075 |
_version_ | 1782465065945923584 |
---|---|
author | Dror, David M. Chakraborty, Arpita Majumdar, Atanu Panda, Pradeep Koren, Ruth |
author_facet | Dror, David M. Chakraborty, Arpita Majumdar, Atanu Panda, Pradeep Koren, Ruth |
author_sort | Dror, David M. |
collection | PubMed |
description | BACKGROUND & OBJECTIVES: The evidence-base of the impact of community-based health insurance (CBHI) on access to healthcare and financial protection in India is weak. We investigated the impact of CBHI in rural Uttar Pradesh and Bihar States of India on insured households’ self-medication and financial position. METHODS: Data originated from (i) household surveys, and (ii) the Management Information System of each CBHI. Study design was “staggered implementation” cluster randomized controlled trial with enrollment of one-third of the treatment group in each of the years 2011, 2012 and 2013. Around 40-50 per cent of the households that were offered to enroll joined. The benefits-packages covered outpatient care in all three locations and in-patient care in two locations. To overcome self-selection enrollment bias, we constructed comparable control and treatment groups using Kernel Propensity Score Matching (K-PSM). To quantify impact, both difference-in-difference (DiD), and conditional-DiD (combined K-PSM with DiD) were used to assess robustness of results. RESULTS: Post-intervention (2013), self-medication was less practiced by insured HHs. Fewer insured households than uninsured households reported borrowing to finance care for non-hospitalization events. Being insured for two years also improved the HH's location along the income distribution, namely insured HHs were more likely to experience income quintile-upgrade in one location, and less likely to experience a quintile-downgrade in two locations. INTERPRETATION & CONCLUSIONS: The realized benefits of insurance included better access to healthcare, reduced financial risks and improved economic mobility, suggesting that in our context health insurance creates welfare gains. These findings have implications for theoretical, ethical, policy and practice considerations. |
format | Online Article Text |
id | pubmed-5094122 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | Medknow Publications & Media Pvt Ltd |
record_format | MEDLINE/PubMed |
spelling | pubmed-50941222016-11-23 Impact of community-based health insurance in rural India on self-medication & financial protection of the insured Dror, David M. Chakraborty, Arpita Majumdar, Atanu Panda, Pradeep Koren, Ruth Indian J Med Res Original Article BACKGROUND & OBJECTIVES: The evidence-base of the impact of community-based health insurance (CBHI) on access to healthcare and financial protection in India is weak. We investigated the impact of CBHI in rural Uttar Pradesh and Bihar States of India on insured households’ self-medication and financial position. METHODS: Data originated from (i) household surveys, and (ii) the Management Information System of each CBHI. Study design was “staggered implementation” cluster randomized controlled trial with enrollment of one-third of the treatment group in each of the years 2011, 2012 and 2013. Around 40-50 per cent of the households that were offered to enroll joined. The benefits-packages covered outpatient care in all three locations and in-patient care in two locations. To overcome self-selection enrollment bias, we constructed comparable control and treatment groups using Kernel Propensity Score Matching (K-PSM). To quantify impact, both difference-in-difference (DiD), and conditional-DiD (combined K-PSM with DiD) were used to assess robustness of results. RESULTS: Post-intervention (2013), self-medication was less practiced by insured HHs. Fewer insured households than uninsured households reported borrowing to finance care for non-hospitalization events. Being insured for two years also improved the HH's location along the income distribution, namely insured HHs were more likely to experience income quintile-upgrade in one location, and less likely to experience a quintile-downgrade in two locations. INTERPRETATION & CONCLUSIONS: The realized benefits of insurance included better access to healthcare, reduced financial risks and improved economic mobility, suggesting that in our context health insurance creates welfare gains. These findings have implications for theoretical, ethical, policy and practice considerations. Medknow Publications & Media Pvt Ltd 2016-06 /pmc/articles/PMC5094122/ /pubmed/27748307 http://dx.doi.org/10.4103/0971-5916.192075 Text en Copyright: © Indian Journal of Medical Research http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms. |
spellingShingle | Original Article Dror, David M. Chakraborty, Arpita Majumdar, Atanu Panda, Pradeep Koren, Ruth Impact of community-based health insurance in rural India on self-medication & financial protection of the insured |
title | Impact of community-based health insurance in rural India on self-medication & financial protection of the insured |
title_full | Impact of community-based health insurance in rural India on self-medication & financial protection of the insured |
title_fullStr | Impact of community-based health insurance in rural India on self-medication & financial protection of the insured |
title_full_unstemmed | Impact of community-based health insurance in rural India on self-medication & financial protection of the insured |
title_short | Impact of community-based health insurance in rural India on self-medication & financial protection of the insured |
title_sort | impact of community-based health insurance in rural india on self-medication & financial protection of the insured |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5094122/ https://www.ncbi.nlm.nih.gov/pubmed/27748307 http://dx.doi.org/10.4103/0971-5916.192075 |
work_keys_str_mv | AT drordavidm impactofcommunitybasedhealthinsuranceinruralindiaonselfmedicationfinancialprotectionoftheinsured AT chakrabortyarpita impactofcommunitybasedhealthinsuranceinruralindiaonselfmedicationfinancialprotectionoftheinsured AT majumdaratanu impactofcommunitybasedhealthinsuranceinruralindiaonselfmedicationfinancialprotectionoftheinsured AT pandapradeep impactofcommunitybasedhealthinsuranceinruralindiaonselfmedicationfinancialprotectionoftheinsured AT korenruth impactofcommunitybasedhealthinsuranceinruralindiaonselfmedicationfinancialprotectionoftheinsured |