Hospital utilization and out of pocket expenditure in public and private sectors under the universal government health insurance scheme in Chhattisgarh State, India: Lessons for universal health coverage

摘要

Research on impact of publicly financed health insurance has paid relatively little attentionto the nature of healthcare provision the schemes engage. India's National Health InsuranceScheme or RSBY was made universal by Chhattisgarh State in 2012. In the State, publicand private sectors provide hospital services in a context of extensive gender, social, economicand geographical inequities. This study examined enrolment, utilization (public andprivate) and out of pocket (OOP) expenditure for the insured and uninsured, in Chhattisgarh.The Chhattisgarh State Central sample (n = 6026 members) of the 2014 National SampleSurvey (71st Round) on Health was extracted and analyzed. Variables of enrolment, hospitalization,out of pocket (OOP) expenditure and catastrophic expenditure were descriptivelyanalyzed. Multivariate analyses of factors associated with enrolment, hospitalization (bysector) and OOP expenditure were conducted, taking into account gender, socio-economicstatus, residence, type of facility and ailment. Insurance coverage was 38.8%. Rates of hospitalizationwere 33/1000 population among the insured and 29/1000 among the uninsured.Of those insured and hospitalized, 67.2% utilized the public sector. Women, rural residents,Scheduled Tribes and poorer groups were more likely to utilize the public sector for hospitalizations.Although the insured were less likely to incur out of pocket (OOP) expenditure,95.1% of insured private sector users and 66.0% of insured public sector users, still incurredcosts. Median OOP payments in the private sector were eight times those in the public sector.Of households with at least one member hospitalized, 35.5% experienced catastrophichealth expenditures (>10% monthly household consumption expenditure).The study finds that despite insurance coverage, the majority still incurred OOP expenditure.The public sector was nevertheless less expensive, and catered to the more vulnerablegroups. It suggests the need to further examine the roles of public and private sectors infinancial risk protection through government health insurance.