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Impact of Publicly Financed Health Insurance Schemes on Healthcare Utilization and Financial Risk Protection in India: A Systematic Review

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  • Shankar Prinja
  • Akashdeep Singh Chauhan
  • Anup Karan
  • Gunjeet Kaur
  • Rajesh Kumar

Abstract

Several publicly financed health insurance schemes have been launched in India with the aim of providing universalizing health coverage (UHC). In this paper, we report the impact of publicly financed health insurance schemes on health service utilization, out-of-pocket (OOP) expenditure, financial risk protection and health status. Empirical research studies focussing on the impact or evaluation of publicly financed health insurance schemes in India were searched on PubMed, Google scholar, Ovid, Scopus, Embase and relevant websites. The studies were selected based on two stage screening PRISMA guidelines in which two researchers independently assessed the suitability and quality of the studies. The studies included in the review were divided into two groups i.e., with and without a comparison group. To assess the impact on utilization, OOP expenditure and health indicators, only the studies with a comparison group were reviewed. Out of 1265 articles screened after initial search, 43 studies were found eligible and reviewed in full text, finally yielding 14 studies which had a comparator group in their evaluation design. All the studies (n-7) focussing on utilization showed a positive effect in terms of increase in the consumption of health services with introduction of health insurance. About 70% studies (n-5) studies with a strong design and assessing financial risk protection showed no impact in reduction of OOP expenditures, while remaining 30% of evaluations (n-2), which particularly evaluated state sponsored health insurance schemes, reported a decline in OOP expenditure among the enrolled households. One study which evaluated impact on health outcome showed reduction in mortality among enrolled as compared to non-enrolled households, from conditions covered by the insurance scheme. While utilization of healthcare did improve among those enrolled in the scheme, there is no clear evidence yet to suggest that these have resulted in reduced OOP expenditures or higher financial risk protection.

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  • Shankar Prinja & Akashdeep Singh Chauhan & Anup Karan & Gunjeet Kaur & Rajesh Kumar, 2017. "Impact of Publicly Financed Health Insurance Schemes on Healthcare Utilization and Financial Risk Protection in India: A Systematic Review," PLOS ONE, Public Library of Science, vol. 12(2), pages 1-19, February.
    • Handle: RePEc:plo:pone00:0170996
    DOI: 10.1371/journal.pone.0170996
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    References listed on IDEAS

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    1. Victoria Fan & Anup Karan & Ajay Mahal, 2012. "State health insurance and out-of-pocket health expenditures in Andhra Pradesh, India," International Journal of Health Economics and Management, Springer, vol. 12(3), pages 189-215, September.
    2. Shankar Prinja & Akashdeep Chauhan & Blake Angell & Indrani Gupta & Stephen Jan, 2015. "A Systematic Review of the State of Economic Evaluation for Health Care in India," Applied Health Economics and Health Policy, Springer, vol. 13(6), pages 595-613, December.
    3. Arindam Nandi & Ashvin Ashok & Ramanan Laxminarayan, 2013. "The Socioeconomic and Institutional Determinants of Participation in India’s Health Insurance Scheme for the Poor," PLOS ONE, Public Library of Science, vol. 8(6), pages 1-13, June.
    4. David Moher & Alessandro Liberati & Jennifer Tetzlaff & Douglas G Altman & The PRISMA Group, 2009. "Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement," PLOS Medicine, Public Library of Science, vol. 6(7), pages 1-6, July.
    5. Planning Commission, 2011. "High Level Expert Group Report on Universal Health Coverage for India," Working Papers id:4646, eSocialSciences.
    6. Dhanaraj, Sowmya, 2014. "Health shocks and coping strategies: State health insurance scheme of Andhra Pradesh, India," WIDER Working Paper Series 003, World Institute for Development Economic Research (UNU-WIDER).
    7. Sowmya Dhanaraj, 2014. "Health Shocks and Coping Strategies: State Health Insurance Scheme of Andhra Pradesh, India," WIDER Working Paper Series wp-2014-003, World Institute for Development Economic Research (UNU-WIDER).
    8. Shankar Prinja & Pankaj Bahuguna & Rakesh Gupta & Atul Sharma & Saroj Kumar Rana & Rajesh Kumar, 2015. "Coverage and Financial Risk Protection for Institutional Delivery: How Universal Is Provision of Maternal Health Care in India?," PLOS ONE, Public Library of Science, vol. 10(9), pages 1-15, September.
    9. Ministry of Statistics and Prog Implementation (MOSPI), 2015. "Key Indicators of Social Consumption in India Health," Working Papers id:7118, eSocialSciences.
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    3. Sulakshana Nandi & Helen Schneider & Priyanka Dixit, 2017. "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 cover," PLOS ONE, Public Library of Science, vol. 12(11), pages 1-18, November.
    4. Dayashankar Maurya, 2019. "Understanding public health insurance in India: A design perspective," International Journal of Health Planning and Management, Wiley Blackwell, vol. 34(4), pages 1633-1650, October.
    5. Prateek Arora & Nirvikar Singh & Abhijit Visaria, 2023. "Healthcare Costs, Choice of Providers and Patient Satisfaction: Survey Evidence from India," Journal of Quantitative Economics, Springer;The Indian Econometric Society (TIES), vol. 21(3), pages 593-616, September.
    6. Puri, Raghav & Sun, Changqing, 2021. "Increasing utilization of public health insurance programs: Evidence from an experiment in India," World Development, Elsevier, vol. 139(C).
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    8. Martinson Ankrah Twumasi & Dennis Asante & Jesse Nuamah Brako & Zhao Ding & Yuansheng Jiang, 2023. "The Relationship between Chronic Non-Communicable Diseases of Fish Farm Household Members and Production Efficiency: The Case of Ghana," IJERPH, MDPI, vol. 20(5), pages 1-13, February.
    9. Sumaiyah Docrat & Donela Besada & Susan Cleary & Crick Lund, 2020. "The impact of social, national and community-based health insurance on health care utilization for mental, neurological and substance-use disorders in low- and middle-income countries: a systematic re," Health Economics Review, Springer, vol. 10(1), pages 1-23, December.
    10. Mansour Esmaeil Zaei & Prachi Kapil & Olha Pelekh & Azadeh Teimoury Nasab, 2018. "Does Micro-Credit Empower Women through Self-Help Groups? Evidence from Punjab, Northern India," Societies, MDPI, vol. 8(3), pages 1-15, July.
    11. Veronika Kalouguina & Joël Wagner, 2020. "How Do Health, Care Services Consumption and Lifestyle Factors Affect the Choice of Health Insurance Plans in Switzerland?," Risks, MDPI, vol. 8(2), pages 1-21, April.
    12. Shankar Prinja & Pankaj Bahuguna & Indrani Gupta & Samik Chowdhury & Mayur Trivedi, 2019. "Role of insurance in determining utilization of healthcare and financial risk protection in India," PLOS ONE, Public Library of Science, vol. 14(2), pages 1-16, February.
    13. Rajesh Chandwani, 2021. "Stakeholders in the Indian Healthcare Sector," Vikalpa: The Journal for Decision Makers, , vol. 46(2), pages 65-70, June.
    14. Shivendra Sangar & Varun Dutt & Ramna Thakur, 2019. "Rural–urban differentials in out-of-pocket health expenditure and resultant impoverishment in India: evidence from NSSO 71st Round," Asia-Pacific Journal of Regional Science, Springer, vol. 3(1), pages 273-291, February.
    15. Shankar Prinja & Akashdeep Singh Chauhan & Pankaj Bahuguna & Sakhtivel Selvaraj & V. R. Muraleedharan & Thiagarajan Sundararaman, 2020. "Cost of Delivering Secondary Healthcare Through the Public Sector in India," PharmacoEconomics - Open, Springer, vol. 4(2), pages 249-261, June.
    16. Shankar Prinja & Jagnoor Jagnoor & Deepshikha Sharma & Sameer Aggarwal & Swati Katoch & P V M Lakshmi & Rebecca Ivers, 2019. "Out-of-pocket expenditure and catastrophic health expenditure for hospitalization due to injuries in public sector hospitals in North India," PLOS ONE, Public Library of Science, vol. 14(11), pages 1-17, November.
    17. Simona Helmsmüller & Andreas Landmann, 2022. "Does free hospitalization insurance change health care consumption of the poor? Short-term evidence from Pakistan," The Geneva Risk and Insurance Review, Palgrave Macmillan;International Association for the Study of Insurance Economics (The Geneva Association), vol. 47(1), pages 238-275, March.

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