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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. Planning Commission, 2011. "High Level Expert Group Report on Universal Health Coverage for India," Working Papers id:4646, eSocialSciences.
    4. 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).
    5. 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.
    6. 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).
    7. 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.
    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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    14. 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.
    15. Rajesh Chandwani, 2021. "Stakeholders in the Indian Healthcare Sector," Vikalpa: The Journal for Decision Makers, , vol. 46(2), pages 65-70, June.
    16. Jacob Novignon & Eric Arthur & Kwasi Gyabaa Tabiri & Yaw Boateng Atakorah & Justice Nonvignon, 2024. "Does health insurance mitigate the economic impact of negative health outcomes? Evidence from Ghana’s National Health Insurance Scheme," Journal of Social and Economic Development, Springer;Institute for Social and Economic Change, vol. 26(2), pages 582-602, August.
    17. 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.
    18. 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.
    19. 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.
    20. 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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