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Bayked EM, Toleha HN, Kebede SZ, Workneh BD, Kahissay MH. The impact of community-based health insurance on universal health coverage in Ethiopia: a systematic review and meta-analysis. Glob Health Action 2023; 16:2189764. [PMID: 36947450 PMCID: PMC10035959 DOI: 10.1080/16549716.2023.2189764] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Ideally health insurance aims to provide financial security, promote social inclusion, and ensure equitable access to quality healthcare services for all households. Community-based health insurance has been operating in Ethiopia since 2011. However, its nationwide impact on universal health coverage has not yet been evaluated despite several studies being conducted. OBJECTIVE We evaluated the impact of Ethiopia's community-based health insurance (2012-2021) on universal health coverage. METHODS On 27 August 2022, searches were conducted in Scopus, Hinari, PubMed, Google Scholar, and Semantic Scholar. Twenty-three studies were included. We used the Joana Briggs Institute checklists to assess the risk of bias. We included cross-sectional and mixed studies with low and medium risk. The data were processed in Microsoft Excel and analyzed using RevMan-5. The impact was measured first on insured households and then on insured versus uninsured households. We used a random model to measure the effect estimates (odds ratios) with a p value < 0.05 and a 95% CI. RESULTS The universal health coverage provided by the scheme was 45.6% (OR = 1.92, 95% CI: 1.44-2.58). Being a member of the scheme increased universal health coverage by 24.8%. The healthcare service utilization of the beneficiaries was 64.5% (OR = 1.95, 95% CI: 1.29-2.93). The scheme reduced catastrophic health expenditure by 79.4% (OR = 4.99, 95% CI: 1.27-19.67). It yielded a 92% (OR = 11.58, 95% CI: 8.12-16.51) perception of health service quality. The health-related quality of life provided by it was 63% (OR = 1.71, 95% CI: 1.50-1.94). Its population coverage was 40.1% (OR = 0.64, 95% CI: 0.41-1.02). CONCLUSION Although the scheme had positive impacts on health service issues by reducing catastrophic costs, the low universal health coverage on a limited population indicates that Ethiopia should move to a broader national scheme that covers the entire population.
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Affiliation(s)
- Ewunetie Mekashaw Bayked
- Department of Pharmacy, College of Medicine and Health Sciences (CMHS), Wollo University, Dessie, Ethiopia
| | - Husien Nurahmed Toleha
- Department of Pharmacy, College of Medicine and Health Sciences (CMHS), Wollo University, Dessie, Ethiopia
| | - Seble Zewdu Kebede
- Department of Pharmacy, Dessie College of Health Sciences (DCHS), Dessie, Ethiopia
| | - Birhanu Demeke Workneh
- Department of Pharmacy, College of Medicine and Health Sciences (CMHS), Wollo University, Dessie, Ethiopia
| | - Mesfin Haile Kahissay
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Eze P, Ilechukwu S, Lawani LO. Impact of community-based health insurance in low- and middle-income countries: A systematic review and meta-analysis. PLoS One 2023; 18:e0287600. [PMID: 37368882 DOI: 10.1371/journal.pone.0287600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 06/08/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND To systematically evaluate the empirical evidence on the impact of community-based health insurance (CBHI) on healthcare utilization and financial risk protection in low- and middle-income countries (LMIC). METHODS We searched PubMed, CINAHL, Cochrane CENTRAL, CNKI, PsycINFO, Scopus, WHO Global Index Medicus, and Web of Science including grey literature, Google Scholar®, and citation tracking for randomized controlled trials (RCTs), non-RCTs, and quasi-experimental studies that evaluated the impact of CBHI schemes on healthcare utilization and financial risk protection in LMICs. We assessed the risk of bias using Cochrane's Risk of Bias 2.0 and Risk of Bias in Non-randomized Studies of Interventions tools for RCTs and quasi/non-RCTs, respectively. We also performed a narrative synthesis of all included studies and meta-analyses of comparable studies using random-effects models. We pre-registered our study protocol on PROSPERO: CRD42022362796. RESULTS We identified 61 articles: 49 peer-reviewed publications, 10 working papers, 1 preprint, and 1 graduate dissertation covering a total of 221,568 households (1,012,542 persons) across 20 LMICs. Overall, CBHI schemes in LMICs substantially improved healthcare utilization, especially outpatient services, and improved financial risk protection in 24 out of 43 studies. Pooled estimates showed that insured households had higher odds of healthcare utilization (AOR = 1.60, 95% CI: 1.04-2.47), use of outpatient health services (AOR = 1.58, 95% CI: 1.22-2.05), and health facility delivery (AOR = 2.21, 95% CI: 1.61-3.02), but insignificant increase in inpatient hospitalization (AOR = 1.53, 95% CI: 0.74-3.14). The insured households had lower out-of-pocket health expenditure (AOR = 0.94, 95% CI: 0.92-0.97), lower incidence of catastrophic health expenditure at 10% total household expenditure (AOR = 0.69, 95% CI: 0.54-0.88), and 40% non-food expenditure (AOR = 0.72, 95% CI: 0.54-0.96). The main limitations of our study are the limited data available for meta-analyses and high heterogeneity persisted in subgroup and sensitivity analyses. CONCLUSIONS Our study shows that CBHI generally improves healthcare utilization but inconsistently delivers financial protection from health expenditure shocks. With pragmatic context-specific policies and operational modifications, CBHI could be a promising mechanism for achieving universal health coverage (UHC) in LMICs.
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Affiliation(s)
- Paul Eze
- Department of Health Policy and Administration, Penn State University, University Park, PA, United States of America
| | - Stanley Ilechukwu
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Health Projects, South Saharan Social Development Organization (SSDO), Independence Layout, Enugu, Nigeria
| | - Lucky Osaheni Lawani
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
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Das AK, Saboo B, Maheshwari A, Nair V M, Banerjee S, C J, V BP, Prasobh P S, Mohan AR, Potty VS, Kesavadev J. Health care delivery model in India with relevance to diabetes care. Heliyon 2022; 8:e10904. [PMID: 36237970 PMCID: PMC9552106 DOI: 10.1016/j.heliyon.2022.e10904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 05/04/2022] [Accepted: 09/29/2022] [Indexed: 11/06/2022] Open
Abstract
The Indian healthcare scenario presents a spectrum of contrasting landscapes. Socioeconomic factors, problems with medical infrastructure, insufficiency in the supply of medical requisites, economic disparities due to major differences in diabetes care delivery in the government and private sectors and difficulty in accessing quality health care facilities challenges effective diabetes care in India. The article gives insights into the practical solutions and the proposed White paper model to resolve major challenges faced by the Indian diabetes care sector for effective diabetes care delivered at Jothydev's Diabetes Educational Forum Global Diabetes Convention 2019. The prevalence of diabetes in India is on its rise. Socioeconomic factors, lack of diagnosis etc challenges Indian diabetes care system. Health care models appropriate for Indian scenario should be developed. Public-Private partnership is required for effective health care delivery.
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Affiliation(s)
- Ashok Kumar Das
- Department of Endocrinology, Pondicherry Institute of Medical Sciences, Pondicherry, Tamil Nadu, India
| | - Banshi Saboo
- Diacare, Diabetes Care & Hormone Clinic, Ahmedabad, India
| | | | | | - Samar Banerjee
- Dept. of Medicine, Vivekananda Institute of Medical Sciences, Kolkata, West Bengal, India
| | - Jayakumar C
- Department of General Medicine, Sree Gokulam Medical College and Research Foundation, Trivandrum, Kerala, India
| | - Benny P. V
- Department of Community Medicine, Sree Gokulam Medical College and Research Foundation, Trivandrum, Kerala, India
| | - Sunil Prasobh P
- Department of Internal Medicine, Government Medical College, Kollam, Kerala, India
| | - Anjana Ranjit Mohan
- Department of Diabetology, Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | | | - Jothydev Kesavadev
- Department of Diabetology, Jothydev's Diabetes Research Centers, Trivandrum, Kerala, India,Corresponding author.
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Sriram S, Khan MM. Effect of health insurance program for the poor on out-of-pocket inpatient care cost in India: evidence from a nationally representative cross-sectional survey. BMC Health Serv Res 2020; 20:839. [PMID: 32894118 PMCID: PMC7487854 DOI: 10.1186/s12913-020-05692-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 08/31/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In India, Out-of-pocket expenses accounts for about 62.6% of total health expenditure - one of the highest in the world. Lack of health insurance coverage and inadequate coverage are important reasons for high out-of-pocket health expenditures. There are many Public Health Insurance Programs offered by the Government that cover the cost of hospitalization for the people below poverty line (BPL), but their coverage is still not complete. The objective of this research is to examine the effect of Public Health Insurance Programs for the Poor on hospitalizations and inpatient Out-of-Pocket costs. METHODS Data from the recent national survey by the National Sample Survey Organization, Social Consumption in Health 2014 are used. Propensity score matching was used to identify comparable non-enrolled individuals for individuals enrolled in health insurance programs. Binary logistic regression model, Tobit model, and a Two-part model were used to study the effects of enrolment under Public Health Insurance Programs for the Poor on the incidence of hospitalizations, length of hospitalization, and Out-of- Pocket payments for inpatient care. RESULTS There were 64,270 BPL people in the sample. Individuals enrolled in health insurance for the poor have 1.21 higher odds of incidence of hospitalization compared to matched poor individuals without the health insurance coverage. Enrollment under the poor people health insurance program did not have any effect on length of hospitalization and inpatient Out-of-Pocket health expenditures. Logistic regression model showed that chronic illness, household size, and age of the individual had significant effects on hospitalization incidence. Tobit model results showed that individuals who had chronic illnesses and belonging to other backward social group had significant effects on hospital length of stay. Tobit model showed that days of hospital stay, education and age of patient, using a private hospital for treatment, admission in a paying ward, and having some specific comorbidities had significant positive effect on out-of-pocket costs. CONCLUSIONS Enrolment in the public health insurance programs for the poor increased the utilization of inpatient health care. Health insurance coverage should be expanded to cover outpatient services to discourage overutilization of inpatient services. To reduce out-of-pocket costs, insurance needs to cover all family members rather than restricting coverage to a specific maximum defined.
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Affiliation(s)
- Shyamkumar Sriram
- Department of Health Services Policy and Management, University of South Carolina, Columbia, SC, USA.
| | - M Mahmud Khan
- Department of Health Services Policy and Management, University of South Carolina, Columbia, SC, USA
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van Hees SGM, O'Fallon T, Hofker M, Dekker M, Polack S, Banks LM, Spaan EJAM. Leaving no one behind? Social inclusion of health insurance in low- and middle-income countries: a systematic review. Int J Equity Health 2019; 18:134. [PMID: 31462303 PMCID: PMC6714392 DOI: 10.1186/s12939-019-1040-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 08/19/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND One way to achieve universal health coverage (UHC) in low- and middle-income countries (LMIC) is the implementation of health insurance schemes. A robust and up to date overview of empirical evidence assessing and substantiating health equity impact of health insurance schemes among specific vulnerable populations in LMICs beyond the more common parameters, such as income level, is lacking. We fill this gap by conducting a systematic review of how social inclusion affects access to equitable health financing arrangements in LMIC. METHODS We searched 11 databases to identify peer-reviewed studies published in English between January 1995 and January 2018 that addressed the enrolment and impact of health insurance in LMIC for the following vulnerable groups: female-headed households, children with special needs, older adults, youth, ethnic minorities, migrants, and those with a disability or chronic illness. We assessed health insurance enrolment patterns of these population groups and its impact on health care utilization, financial protection, health outcomes and quality of care. RESULTS The comprehensive database search resulted in 44 studies, in which chronically ill were mostly reported (67%), followed by older adults (33%). Scarce and inconsistent evidence is available for individuals with disabilities, female-headed households, ethnic minorities and displaced populations, and no studies were yielded reporting on youth or children with special needs. Enrolment rates seemed higher among chronically ill and mixed or insufficient results are observed for the other groups. Most studies reporting on health care utilization found an increase in health care utilization for insured individuals with a disability or chronic illness and older adults. In general, health insurance schemes seemed to prevent catastrophic health expenditures to a certain extent. However, reimbursements rates were very low and vulnerable individuals had increased out of pocket payments. CONCLUSION Despite a sizeable literature published on health insurance, there is a dearth of good quality evidence, especially on equity and the inclusion of specific vulnerable groups in LMIC. Evidence should be strengthened within health care reform to achieve UHC, by redefining and assessing vulnerability as a multidimensional process and the investigation of mechanisms that are more context specific.
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Affiliation(s)
- Suzanne G M van Hees
- Radboud Institute for Health Sciences (RIHS), Department for Health Evidence, Radboud University Medical Centre, Nijmegen, The Netherlands.
- Department of Work and Health, HAN University of Applied Sciences, Kapittelweg 33, P.O. Box 6960, 6503GL, Nijmegen, Netherlands.
| | - Timothy O'Fallon
- International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Marleen Dekker
- African Studies Center, Leiden University, Leiden, The Netherlands
| | - Sarah Polack
- International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine, London, UK
| | - Lena Morgon Banks
- International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine, London, UK
| | - Ernst J A M Spaan
- Radboud Institute for Health Sciences (RIHS), Department for Health Evidence, Radboud University Medical Centre, Nijmegen, The Netherlands
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Whether the industrial workers of slums have access to job insurance? INTERNATIONAL JOURNAL OF WORKPLACE HEALTH MANAGEMENT 2019. [DOI: 10.1108/ijwhm-08-2018-0110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Purpose
Securing a job in an industry is a boon for most of the slum dwellers. When the primary earner of a slum household suffers from occupational illness and injuries, without insurance coverage or partial coverage of insurance, this boon may become a curse in the long run. The occupational security and safety along with the fact that whether such workers are insured is an important aspect and has a close link with the expenditure on illness. Thus, the accessibility to employees’ insurance in the risky industrial occupation, particularly for slum dwellers, is crucial to protect them from falling into poverty. Studies on occupational health of the poor workers are either limited to informal sectors or remain industry specific and the analysis of their accessibility to job insurance is rarely done. The paper aims to discuss these issues.
Design/methodology/approach
The research questions are framed to analyze the types of insurance accessible to workers across various industries; the accessibility to insurance, however, varying across risk intensities of various industries; and the determinants of insurance accessibility of the industrial workers living in slums. The determinants of accessibility of job insurance are analyzed with a binary Logit model. A multi-stage random sampling technique is used to collect the primary data from 320 industrial workers living in the slums of the Indian state of West Bengal.
Findings
The industrial workers, irrespective of the types of industries, are exposed to a high-risk category without proper job insurance. The higher industrial income is not adequate to prevent financial hardships. Access to insurance is more likely for the respondents with job tenure of more than two years and less likely for the workers who are working for more than eight hours per day.
Social implications
This study provides a significant insight to the policymakers concerning health dynamics of the slum dwellers, which can improve their livelihood.
Originality/value
The analysis of the industry-specific risk intensities with accessibility to insurance contributes to understanding the coverage of the insurance scheme for the workers in slums.
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Mishra S, Kusuma YS, Babu BV. Treatment-seeking and out-of-pocket expenditure on childhood illness in a migrant tribal community in Bhubaneswar, Odisha State, India. Paediatr Int Child Health 2017; 37:181-187. [PMID: 27922342 DOI: 10.1080/20469047.2016.1245031] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND In India, migrant status, tribal affiliation and poverty render tribal migrants more vulnerable than any other group which leads to high treatment costs and the risk of low access to health care. OBJECTIVE To examine treatment-seeking behaviour and out-of-pocket (OOP) expenditure on the treatment of childhood illnesses, with a focus on gender in a migrant tribal community in Bhubaneswar, eastern India. METHODS A total of 175 households with a child aged 0-14 years and who had migrated within the last 12 years were selected from tribal-dominated slums. Data on health-seeking behaviour and expenditure on a recent illness in the youngest child were collected by interviewing mothers during October 2007 to March 2008. RESULTS Of the 175 children, 78.8% had at least one episode of illness during the previous year. Of the total number of episodes, 71% had been treated and 61% of them had incurred OOP expenditure. A significantly lower proportion of episodes of illness in girls had been treated than in boys (P = 0.01) and incurred OOP expenditure (P = 0.05). Private health care was preferred and only 16.5% availed themselves of the government sources. About 89 and 87% of households of boys and girls, respectively, incurred OOP expenditure. A child's gender (female) (P = 0.05), mother's education (P = 0.002) and type of illness (P = 0.002) were significantly associated with total OOP expenditure. CONCLUSION Further studies are warranted to address the low access to government health care and thereby reduce high OOP expenditure by tribal migrants on low incomes. Efforts are required to increase the ability of communities and health providers to identify and address the issues of gender and equity in health care along with a focus on culture-sensitive service provision.
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Affiliation(s)
- Suchismita Mishra
- a Department of Anthropology , Sambalpur University , Sambalpur , India
| | | | - Bontha V Babu
- b Health Systems Research Division , Indian Council of Medical Research , New Delhi , India
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Karan A, Yip W, Mahal A. Extending health insurance to the poor in India: An impact evaluation of Rashtriya Swasthya Bima Yojana on out of pocket spending for healthcare. Soc Sci Med 2017; 181:83-92. [PMID: 28376358 PMCID: PMC5408909 DOI: 10.1016/j.socscimed.2017.03.053] [Citation(s) in RCA: 111] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Revised: 03/16/2017] [Accepted: 03/24/2017] [Indexed: 11/26/2022]
Abstract
India launched the 'Rashtriya Swasthya Bima Yojana' (RSBY) health insurance scheme for the poor in 2008. Utilising 3 waves (1999-2000, 2004-05 and 2011-12) of household level data from nationally representative surveys of the National Sample Survey Organisation (NSSO) (N = 346,615) and district level RSBY administrative data on enrolment, we estimated causal effects of RSBY on out-of-pocket expenditure. Using 'difference-in-differences' methods on households in matched districts we find that RSBY did not affect the likelihood of inpatient out-of-pocket spending, the level of inpatient out of pocket spending or catastrophic inpatient spending. We also do not find any statistically significant effect of RSBY on the level of outpatient out-of-pocket expenditure and the probability of incurring outpatient expenditure. In contrast, the likelihood of incurring any out of pocket spending (inpatient and outpatient) rose by 30% due to RSBY and was statistically significant. Although out of pocket spending levels did not change, RSBY raised household non-medical spending by 5%. Overall, the results suggest that RSBY has been ineffective in reducing the burden of out-of-pocket spending on poor households.
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Affiliation(s)
- Anup Karan
- Indian Institute of Public Health Delhi (IIPHD), Public Health Foundation of India, Delhi NCR, India.
| | - Winnie Yip
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Harvard University, Boston, USA
| | - Ajay Mahal
- Nossal Institute for Global Health, University of Melbourne, Melbourne, Australia
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Noel JK. Public health care funding modifies the effect of out-of-pocket spending on maternal, infant, and child mortality. Health Care Women Int 2017; 38:253-266. [DOI: 10.1080/07399332.2016.1254217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Jonathan K. Noel
- Department of Community Medicine and Health Care, University of Connecticut School of Medicine, Farmington, Connecticut, USA
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Raza WA, van de Poel E, Bedi A, Rutten F. Impact of Community-based Health Insurance on Access and Financial Protection: Evidence from Three Randomized Control Trials in Rural India. HEALTH ECONOMICS 2016; 25:675-687. [PMID: 26708298 DOI: 10.1002/hec.3307] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 11/16/2015] [Accepted: 11/23/2015] [Indexed: 06/05/2023]
Abstract
Since the 1990s, community-based health insurance (CBHI) schemes have been proposed to reduce the financial consequences of illness and enhance access to healthcare in developing countries. Convincing evidence on the ability of such schemes to meet their objectives is scarce. This paper uses randomized control trials conducted in rural Uttar Pradesh and Bihar (India) to evaluate the effects of three CBHI schemes on healthcare utilization and expenditure. We find that the schemes have no effect on these outcomes. The results suggest that CBHI schemes of the type examined in this paper are unlikely to have a substantial impact on access and financial protection in developing countries. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Wameq A Raza
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
- Research and Evaluation Division, BRAC, Dhaka, Bangladesh
| | - Ellen van de Poel
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Arjun Bedi
- International Institute of Social Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Frans Rutten
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
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Browne JL, Kayode GA, Arhinful D, Fidder SAJ, Grobbee DE, Klipstein-Grobusch K. Health insurance determines antenatal, delivery and postnatal care utilisation: evidence from the Ghana Demographic and Health Surveillance data. BMJ Open 2016; 6:e008175. [PMID: 26993621 PMCID: PMC4800135 DOI: 10.1136/bmjopen-2015-008175] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE This study aims to evaluate the effect of maternal health insurance status on the utilisation of antenatal, skilled delivery and postnatal care. DESIGN A population-based cross-sectional study. SETTING AND PARTICIPANTS We utilised the 2008 Demographic and Health Survey data of Ghana, which included 2987 women who provided information on maternal health insurance status. PRIMARY OUTCOMES Utilisation of antenatal, skilled delivery and postnatal care. STATISTICAL ANALYSES Multivariable logistic regression was applied to determine the independent association between maternal health insurance and utilisation of antenatal, skilled delivery and postnatal care. RESULTS After adjusting for socioeconomic, demographic and obstetric factors, we observed that among insured women the likelihood of having antenatal care increased by 96% (OR 1.96; 95% CI 1.52 to 2.52; p value<0.001) and of skilled delivery by 129% (OR 2.29; 95% CI 1.92 to 2.74; p value<0.001), while postnatal care among insured women increased by 61% (OR 1.61; 95% CI 1.17 to 2.21; p value<0.01). CONCLUSIONS This study demonstrated that maternal health insurance status plays a significant role in the uptake of the maternal, neonatal and child health continuum of care service.
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Affiliation(s)
- Joyce L Browne
- Julius Global Health, Julius Centrum for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gbenga A Kayode
- Julius Global Health, Julius Centrum for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Daniel Arhinful
- Noguchi Memorial Institute of Medical Research, University of Ghana, Accra, Ghana
| | - Samuel A J Fidder
- Julius Global Health, Julius Centrum for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Diederick E Grobbee
- Julius Global Health, Julius Centrum for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Centrum for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- Division of Epidemiology & Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Manjunath U, Kumar CS, Kailashnath M. Comparison of Cost Structure, Package Rates and Financial Feasibility for Selected Surgeries Covered under Social Health Insurance Schemes. JOURNAL OF HEALTH MANAGEMENT 2016. [DOI: 10.1177/0972063415625514] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Social Health Insurance Scheme is an important innovation in health financing in India. The present study analyzed the cost and net realization by a multi-specialty/tertiary care hospital in treating the patients covered under two of the most successful Social Health Insurance Schemes—Yeshasvini and Kalaignar. A comparative analysis of the cost structure, package rates sanctioned by the schemes and the financial feasibility of the schemes for 210 surgeries in 12 specialties was conducted in a large hospital. In general, cost of consumables and manpower constituted nearly 70 per cent of the total cost. Only in four surgical categories, the tariff rate was adequate to meet the direct cost of care. Implications for improving net realization by the hospital as well as the scheme policy are discussed. Study Objectives To carry out a comparative analysis of the cost structure of the major procedures in the hospital covered under Yeshasvini and Kalaignar schemes; To compare the cost structure/s incurred by the hospital with the package rates approved by the schemes to evaluate the financial feasibility of the schemes across various departments of the hospital; and To suggest measures to reduce the costs of production for various procedures without negatively impacting the quality of care and, thereby, reduce the gap between the costs incurred by the hospital and the realization from the schemes. Methodology The cost incurred by the hospital in treating the patients covered under the two schemes—Yeshasvini and Kalaignar—for 210 surgical cases was analyzed. The costs of various resources on a per-patient basis including consumables, manpower, electricity, equipment, and use of facilities in and around the hospital were computed. Net realization by the hospital in the corresponding surgeries was computed by taking the approval amount (package rates) and total cost of care. The analysis was carried out for both the schemes by classifying data as ‘cardiac’ and ‘non-cardiac’ procedures. Results and Conclusions In general, Kalaignar scheme showed better cost recoveries than Yeshasvini scheme for similar types of cardiac and non-cardiac procedures. In all the cases studied, the major costs were attributable to cost of medicine and consumables and cost of manpower. The cost of medicine and consumables in cardiac and non-cardiac surgeries was 37 per cent and 29 per cent of the total cost, respectively. Manpower costs in the two types of surgeries were 42.5 per cent and 47.5 per cent, respectively. Net realization for all surgeries studied, showed that cardiac cases gave a better cost recovery than non-cardiac categories. It was observed that only 4 of the 12 surgical procedures studied posted earnings more than the total cost indicating low financial viability for the hospital. Implications for managers for reducing losses to the hospital are discussed. Large-scale studies on costing for various procedures across the networked and non-networked hospitals are warranted for revising package rates by the social insurance schemes.
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Affiliation(s)
- Usha Manjunath
- PhD, Professor and Dean, Academic and Student Affairs, IIHMR, Bangalore, India
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Raza WA, Van de Poel E, Panda P, Dror D, Bedi A. Healthcare seeking behaviour among self-help group households in Rural Bihar and Uttar Pradesh, India. BMC Health Serv Res 2016; 16:1. [PMID: 26728278 PMCID: PMC4698810 DOI: 10.1186/s12913-015-1254-9] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 12/24/2015] [Indexed: 11/17/2022] Open
Abstract
Background In recent years, supported by non-governmental organizations (NGOs), a number of community-based health insurance (CBHI) schemes have been operating in rural India. Such schemes design their benefit packages according to local priorities. This paper examines healthcare seeking behaviour among self-help group households with a view to understanding the implications for the benefit packages offered by such schemes. Methods We use cross-sectional data collected from two of India’s poorest states and estimate an alternative-specific conditional logit model to examine healthcare seeking behaviour. Results We find that the majority of respondents do access some form of care and that there is overwhelming use of private providers. Non-degree allopathic providers (NDAP) also called rural medical practitioners are the most popular providers. In the case of acute illnesses, proximity plays an important role in determining provider choice. For chronic illnesses, cost of care influences provider choice. Conclusion Given the importance of proximity in determining provider choice, benefit packages offered by CBHI schemes should consider coverage of transportation costs and reimbursement of foregone earnings. Electronic supplementary material The online version of this article (doi:10.1186/s12913-015-1254-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Wameq A Raza
- Institute of Health Policy and Management, Erasmus University Rotterdam, J5-23, P.O. Box 1738, 3000, DR, Rotterdam, The Netherlands. .,Research and Evaluation Division, BRAC, Dhaka, Bangladesh.
| | - Ellen Van de Poel
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | | | - David Dror
- Micro Insurance Academy, India and Erasmus University Rotterdam, The Hague, The Netherlands
| | - Arjun Bedi
- International Institute of Social Studies (ISS), Erasmus University Rotterdam, The Netherlands and Georgetown University, Doha, Qatar
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Adomah-Afari A. The contribution of community leadership upon the performance of mutual health organisations in Ghana. J Health Organ Manag 2015; 29:822-39. [PMID: 26556153 DOI: 10.1108/jhom-11-2013-0260] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this paper is to investigate the effect of social dynamics on the performance of mutual health organisations (MHOs) exploring the influence of community wealth and community leadership on policy implementation. DESIGN/METHODOLOGY/APPROACH Four operating district mutual health insurance schemes were selected using geographical locations, among other criteria, as case studies. Data were gathered through interviews and documentary review. The findings were analysed using community field and social capital theories. FINDINGS Traditional leaders like the Chiefs serve as the pivot around which social and human capital of the communities revolve in the developmental process of the country. RESEARCH LIMITATIONS/IMPLICATIONS Lack of exhaustive examination of the financial and institutional viability issues of the MHOs. Future studies could assess the interplay between financial, institutional and social viability models when measuring the financial and overall sustainability of MHOs. PRACTICAL IMPLICATIONS Health policy makers need to involve traditional leaders in the formulation and implementation of national policies since their acceptance or rejection of central government policy could have negative consequences. SOCIAL IMPLICATIONS Ghana is a dynamic country and there is the need to utilise existing social networks: inter-family and inter-tribal relationships to ensure the viability of MHOs. ORIGINALITY/VALUE There is and can be a successful interplay between public sector funding and community sector revenue mobilisation for financing the health sector in Ghana. This justifies the complementarity between government funding and community's resource mobilisation efforts in the health sector.
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Borghi J, Ramsey K, Kuwawenaruwa A, Baraka J, Patouillard E, Bellows B, Binyaruka P, Manzi F. Protocol for the evaluation of a free health insurance card scheme for poor pregnant women in Mbeya region in Tanzania: a controlled-before and after study. BMC Health Serv Res 2015; 15:258. [PMID: 26141724 PMCID: PMC4490646 DOI: 10.1186/s12913-015-0905-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 06/05/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The use of demand-side financing mechanisms to increase health service utilisation among target groups and enhance service quality is gaining momentum in many low- and middle-income countries. However, there is limited evidence on the effects of such schemes on equity, financial protection, quality of care, and cost-effectiveness. A scheme providing free health insurance cards to poor pregnant women and their households was first introduced in two regions of Tanzania in 2011 and gradually expanded in 2012. METHODS A controlled before and after study will examine in one district the effect of the scheme on utilization, quality, and cost of healthcare services accessed by poor pregnant women and their households in Tanzania. Data will be collected 4 months before implementation of the scheme and 17 months after the start of implementation from a survey of 24 health facilities, 288 patients exiting consultations and 1500 households of women who delivered in the previous year in one intervention district (Mbarali). 288 observations of provider-client interactions will also be carried out. The same data will be collected from a comparison district in a nearby region. A process evaluation will ascertain how the scheme is implemented in practice and the level of implementation fidelity and potential moderators. The process evaluation will draw from impact evaluation data and from three rounds of data collection at the national, regional, district, facility and community levels. An economic evaluation will measure the cost-effectiveness of the scheme relative to current practice from a societal perspective. DISCUSSION This evaluation will generate evidence on the impact and cost-effectiveness of targeted health insurance for pregnant women in a low income setting, as well as building a better understanding of the implementation process and challenges for programs of this nature.
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Affiliation(s)
- Josephine Borghi
- Ifakara Health Institute, Kiko Avenue, Dar es Salaam, Tanzania. .,Department of Global Health and Development, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
| | - Kate Ramsey
- Columbia University, Mailman School of Public Health, New York, NY, USA
| | | | - Jitihada Baraka
- Ifakara Health Institute, Kiko Avenue, Dar es Salaam, Tanzania
| | - Edith Patouillard
- Ifakara Health Institute, Kiko Avenue, Dar es Salaam, Tanzania.,Department of Global Health and Development, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | | | - Peter Binyaruka
- Ifakara Health Institute, Kiko Avenue, Dar es Salaam, Tanzania
| | - Fatuma Manzi
- Ifakara Health Institute, Kiko Avenue, Dar es Salaam, Tanzania
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Desai S, Sinha T, Mahal A, Cousens S. Understanding CBHI hospitalisation patterns: a comparison of insured and uninsured women in Gujarat, India. BMC Health Serv Res 2014; 14:320. [PMID: 25064209 PMCID: PMC4114097 DOI: 10.1186/1472-6963-14-320] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 07/14/2014] [Indexed: 11/10/2022] Open
Abstract
Background Community-based health insurance has been associated with increased hospitalisation in low-income settings, but with limited analysis of the illnesses for which claims are submitted. A review of claims submitted to VimoSEWA, an inpatient insurance scheme in Gujarat, India, found that fever, diarrhoea and hysterectomy, the latter at a mean age of 37 years, were the leading reasons for claims by adult women. We compared the morbidity, outpatient treatment-seeking and hospitalisation patterns of VimoSEWA-insured women with uninsured women. Methods We utilised data from a cross-sectional survey of 1,934 insured and uninsured women in Gujarat, India. Multivariable logistic regression identified predictors of insurance coverage and the association of insurance with hospitalisation. Self-reported data on morbidity, outpatient care and hospitalisation were compared between insured and uninsured women. Results Age, marital status and occupation of adult women were associated with insurance status. Reported recent morbidity, type of illness and outpatient treatment were similar among insured and uninsured women. Multivariable analysis revealed strong evidence of a higher odds of hospitalisation amongst the insured (OR = 2.7; 95% ci. 1.6, 4.7). The leading reason for hospitalisation for uninsured and insured women was hysterectomy, at a similar mean age of 36, followed by common ailments such as fever and diarrhoea. Insured women appeared to have a higher probability of being hospitalised than uninsured women for all causes, rather than specifically for fever, diarrhoea or hysterectomy. Length of stay was similar while choice of hospital differed between insured and uninsured women. Conclusions Despite similar reported morbidity patterns and initial treatment-seeking behaviour, VimoSEWA members were more likely to be hospitalised. The data did not provide strong evidence that inpatient hospitalisation replaced outpatient treatment for common illnesses or that insurance was the primary inducement for hysterectomy in the population. Rather, it appears that VimoSEWA members behaved differently in deciding if, and where, to be hospitalised for any condition. Further research is required to explore this decision-making process and roles, if any, played by adverse selection and moral hazard. Lastly, these hospitalisation patterns raise concerns regarding population health needs and access to quality preventive and outpatient services.
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Affiliation(s)
- Sapna Desai
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
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Jain A, Swetha S, Johar Z, Raghavan R. Acceptability of, and willingness to pay for, community health insurance in rural India. J Epidemiol Glob Health 2014; 4:159-67. [PMID: 25107651 PMCID: PMC7333818 DOI: 10.1016/j.jegh.2013.12.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 12/02/2013] [Accepted: 12/08/2013] [Indexed: 11/30/2022] Open
Abstract
Objectives: To understand the acceptability of, and willingness to pay for, community health insurance coverage among residents of rural India. Methods: We conducted a mixed methods study of 33 respondents located in 8 villages in southern India. Interview domains focused on health-seeking behaviors of the family for primary healthcare, household expenditures on primary healthcare, interest in pre-paid health insurance, and willingness to pay for such a product. Results: Most respondents reported that they would seek care only when symptoms were manifest; only 6 respondents recognized the importance of preventative services. None reported impoverishment due to health expenditures. Few viewed health insurance as necessary either because they did not wish to be early adopters, because they had alternate sources of financial support, or because of concerns with the design of insurance coverage or the provider. Those who were interested reported being willing to pay Rs. 1500 ($27) as the modal annual insurance premium. Conclusions: Penetration of community health insurance programs in rural India will require education of the consumer base, careful attention to premium rate setting, and deeper understanding of social networks that may act as financial substitutes for health insurance.
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Affiliation(s)
- Ankit Jain
- IKP Centre for Technologies in Public Health, A2, Amsavalli Illam, 7th Cross Street, Arulananda Nagar, Thanjavur 613007, India
| | - Selva Swetha
- IKP Centre for Technologies in Public Health, A2, Amsavalli Illam, 7th Cross Street, Arulananda Nagar, Thanjavur 613007, India
| | - Zeena Johar
- IKP Centre for Technologies in Public Health, A2, Amsavalli Illam, 7th Cross Street, Arulananda Nagar, Thanjavur 613007, India
| | - Ramesh Raghavan
- Washington University in St. Louis, Brown School, Campus Box 1196, One Brookings Drive, St. Louis, MO 63130, USA.
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Aji B, De Allegri M, Souares A, Sauerborn R. The impact of health insurance programs on out-of-pocket expenditures in Indonesia: an increase or a decrease? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2013; 10:2995-3013. [PMID: 23873263 PMCID: PMC3734472 DOI: 10.3390/ijerph10072995] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 07/04/2013] [Accepted: 07/08/2013] [Indexed: 11/16/2022]
Abstract
We used panel data from the Indonesian Family Life Survey to investigate the impact of health insurance programs on reducing out-of-pocket expenditures. We employed three linear panel data models, two of which accounted for endogeneity: pooled ordinary least squares (OLS), pooled two-stage least squares (2SLS) for instrumental variable (IV), and fixed effects (FE). The study revealed that two health insurance programs had a significantly negative impact on out-of-pocket expenditures by using IV estimates. In the IV model, Askeskin decreased out-of-pocket expenditures by 34% and Askes by 55% compared with non-Askeskin and non-Askes, respectively, while Jamsostek was found to bear a nonsignificant effect on out-of-pocket expenditures. In the FE model, only Askeskin had a significant negative effect with an 11% reduction on out-of-pocket expenditures. This study showed that two large existing health insurance programs in Indonesia, Askeskin and Askes, effectively reduced household out-of-pocket expenditures. The ability of programs to offer financial protection by reducing out-of-pocket expenditures is likely to be a direct function of their benefits package and co-payment policies.
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Affiliation(s)
- Budi Aji
- Institute of Public Health, Faculty of Medicine, University of Heidelberg, Im Neuenheimer Feld 324, Heidelberg 69120, Germany; E-Mails: (M.D.A.); (A.S.); (R.S.)
- School of Public Health, Faculty of Medicine and Health Sciences, Jenderal Soedirman University, Kampus Karangwangkal, Purwokerto 53123, Indonesia
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +49-6221-563-6158; Fax: +49-6221-565-051
| | - Manuela De Allegri
- Institute of Public Health, Faculty of Medicine, University of Heidelberg, Im Neuenheimer Feld 324, Heidelberg 69120, Germany; E-Mails: (M.D.A.); (A.S.); (R.S.)
| | - Aurelia Souares
- Institute of Public Health, Faculty of Medicine, University of Heidelberg, Im Neuenheimer Feld 324, Heidelberg 69120, Germany; E-Mails: (M.D.A.); (A.S.); (R.S.)
| | - Rainer Sauerborn
- Institute of Public Health, Faculty of Medicine, University of Heidelberg, Im Neuenheimer Feld 324, Heidelberg 69120, Germany; E-Mails: (M.D.A.); (A.S.); (R.S.)
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Wangnoo SK, Maji D, Das AK, Rao PV, Moses A, Sethi B, Unnikrishnan AG, Kalra S, Balaji V, Bantwal G, Kesavadev J, Jain SM, Dharmalingam M. Barriers and solutions to diabetes management: An Indian perspective. Indian J Endocrinol Metab 2013; 17:594-601. [PMID: 23961474 PMCID: PMC3743358 DOI: 10.4103/2230-8210.113749] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
India, with one of the largest and most diverse populations of people living with diabetes, experiences significant barriers in successful diabetes care. Limitations in appropriate and timely use of insulin impede the achievement of good glycemic control. The current article aims to identify solutions to barriers in the effective use of insulin therapy viz. its efficacy and safety, impact on convenience and life-style and lack of awareness and education. Therapeutic modalities, which avoid placing an undue burden on patients' life-style, must be built. These should incorporate patient-centric paradigms of diabetes care, team-based approach for life-style modification and monitoring of patients' adherence to therapy. To address the issues in efficacy and safety, long-acting, flat profile basal insulin, which mimics physiological insulin and show fewer hypoglycemic events is needed. In addition, therapy must be linked to monitoring of blood glucose to enable effective use of insulin therapy. In conjunction, wide-ranging efforts must be made to remove negative perception of insulin therapy in the community. Patient- and physician - targeted programs to enhance awareness in various aspects of diabetes care must be initiated across all levels of health-care ensuring uniformity of information. To successfully address the challenges in facing diabetes care, partnerships between various stakeholders in the care process must be explored.
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Affiliation(s)
- Subhash K. Wangnoo
- Department of Endocrinology, Indraprastha Apollo Hospital, New Delhi, India
| | - Debasish Maji
- Department of Medicine, Vivekananda Institute of Medical Sciences, Kolkata, India
| | - Ashok Kumar Das
- Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - P. V. Rao
- Department of Endocrinology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Anand Moses
- Director, Institute of Diabetology, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, India
| | - Bipin Sethi
- Department of Endocrinology, Care Hospital, Hyderabad, India
| | | | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital and B.R.I.D.E, Karnal, India
| | - V. Balaji
- Senior Consultant Diabetologist, Dr. V. Seshiah Diabetes Research Institute and Dr. Balaji Diabetes Care Center, Chennai, India
| | - Ganapathi Bantwal
- Department of Endocrinology, St. John's Medical College Hospital, Bangalore, India
| | - Jothydev Kesavadev
- CEO and Director, Jothydev's Diabetes Research Center, Trivandrum, India
| | - Sunil M. Jain
- Managing Director, TOTALL Diabetes Hormone Institute, Indore, India
| | - Mala Dharmalingam
- Department of Endocrinology, MS Ramaiah Medical College, Bangalore, India
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Sinha T, Desai S, Mahal A. Hospitalized for fever? Understanding hospitalization for common illnesses among insured women in a low-income setting. Health Policy Plan 2013; 29:475-82. [PMID: 23749652 DOI: 10.1093/heapol/czt032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Health microinsurance is a financial tool that increases utilization of health care services among low-income persons. There is limited understanding of the illnesses for which insured persons are hospitalized. Analysis of health claims at VimoSEWA, an Indian microinsurance scheme, shows that a significant proportion of hospitalization among insured adult women is for common illnesses—fever, diarrhoea and malaria—that are amenable to outpatient treatment. This study aims to understand the factors that result in hospitalization for common illnesses. METHODS The article uses a mixed methods approach. Quantitative data were collected from a household survey of 816 urban low-income households in Gujarat, India. The qualitative data are based on 10 in-depth case studies of insured women hospitalized for common illnesses and interviews with five providers. Quantitative and qualitative data were supplemented with data from the insurance scheme’s administrative records. RESULTS Socioeconomic characteristics and morbidity patterns among insured and uninsured women were similar with fever the most commonly reported illness. While fever was the leading cause for hospitalization among insured women, no uninsured women were hospitalized for fever. Qualitative investigation indicates that 9 of 10 hospitalized women first sought outpatient treatment. Precipitating factors for hospitalization were either the persistence or worsening of symptoms. Factors that facilitated hospitalization included having insurance and the perceptions of doctors regarding the need for hospitalization. CONCLUSION In the absence of quality primary care, health insurance can lead to hospitalization for non-serious illnesses. Deterrents to hospitalization point away from member moral hazard; provider moral hazard cannot be ruled out. This study underscores the need for quality primary health care and its better integration with health microinsurance schemes.
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Fan VY, Karan A, Mahal A. State health insurance and out-of-pocket health expenditures in Andhra Pradesh, India. ACTA ACUST UNITED AC 2012; 12:189-215. [DOI: 10.1007/s10754-012-9110-5] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Accepted: 06/05/2012] [Indexed: 11/24/2022]
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Ozawa S, Walker DG. Comparison of trust in public vs private health care providers in rural Cambodia. Health Policy Plan 2011; 26 Suppl 1:i20-9. [PMID: 21729914 DOI: 10.1093/heapol/czr045] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
How trust in providers affects health care-seeking behaviour is not well understood. Focus groups and household surveys were conducted in Cambodia to examine how villagers describe their trust in public and private providers, and to assess whether a difference exists in provider trust levels. Our findings suggest the reasons for trusting public and private providers differ, and that villagers' trust in and relationship with providers is one of the important considerations affecting where they seek care. People believed that public providers were 'honest' and 'sincere', did not 'bad mouth people' and explained the 'status of [the] disease'. Villagers trusted public providers for their skills and abilities, and for an effective referral system. In contrast, respondents noted that seeing private providers was 'comfortable and easy', that they 'come to our home' and patients can 'owe [them] some money'. Private providers were trusted for being very friendly and approachable, extremely thorough and careful, and easy to contact. Among those who sought care in the past 30 days, trust in the health care provider was listed as the fifth and second most important consideration for choosing public or private providers, respectively. This study illustrates the importance of trust as a unique concept that can affect people's choice of health care providers in a low-income country.
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Affiliation(s)
- Sachiko Ozawa
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St E8003, Baltimore, MD 21205, USA.
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Michielsen J, Criel B, Devadasan N, Soors W, Wouters E, Meulemans H. Can health insurance improve access to quality care for the Indian poor? Int J Qual Health Care 2011; 23:471-86. [DOI: 10.1093/intqhc/mzr025] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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