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Analysis of multi drug resistant tuberculosis (MDR-TB) financial protection policy: MDR-TB health insurance schemes, in Chhattisgarh state, India

Author

Listed:
  • Debashish Kundu

    (International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Office)

  • Nandini Sharma

    (Department of Community Medicine, Maulana Azad Medical College)

  • Sarabjit Chadha

    (International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Office)

  • Samia Laokri

    (Universite Libre de Bruxelles)

  • George Awungafac

    (African Society of Laboratory Medicine; Ministry of Health, Cameroon)

  • Lai Jiang

    (KU Leuven)

  • Miqdad Asaria

    (Global Health and Development, Imperial College London; Centre for Health Economics, University of York)

Abstract

Introduction There are significant financial barriers to access treatment for multi drug resistant tuberculosis (MDR-TB) in India. To address these challenges, Chhattisgarh state in India has established a MDR-TB financial protection policy by creating MDR-TB benefit packages as part of the universal health insurance scheme that the state has rolled out in their effort towards attaining Universal Health Coverage for all its residents. In these schemes the state purchases health insurance against set packages of services from third party health insurance agencies on behalf of all its residents. Provider payment reform by strategic purchasing through output based payments (lump sum fee is reimbursed as per the MDR-TB benefit package rates) to the providers – both public and private health facilities empanelled under the insurance scheme was the key intervention. Aim To understand the implementation gap between policy and practice of the benefit packages with respect to equity in utilization of package claims by the poor patients in public and private sector. Methods Data from primary health insurance claims from January 2013 to December 2015, were analysed using an extension of ‘Kingdon’s multiple streams for policy implementation framework’ to explain the implementation gap between policy and practice of the MDR-TB benefit packages. Results The total number of claims for MDR-TB benefit packages increased over the study period mainly from poor patients treated in public facilities, particularly for the pre-treatment evaluation and hospital stay packages. Variations and inequities in utilizing the packages were observed between poor and non-poor beneficiaries in public and private sector. Private providers participation in the new MDR-TB financial protection mechanism through the universal health insurance scheme was observed to be much lower than might be expected given their share of healthcare provision overall in India. Conclusion Our findings suggest that there may be an implementation gap due to weak coupling between the problem and the policy streams, reflecting weak coordination between state nodal agency and the state TB department. There is a pressing need to build strong institutional capacity of the public and private sector for improving service delivery to MDR-TB patients through this new health insurance mechanism.

Suggested Citation

  • Debashish Kundu & Nandini Sharma & Sarabjit Chadha & Samia Laokri & George Awungafac & Lai Jiang & Miqdad Asaria, 2018. "Analysis of multi drug resistant tuberculosis (MDR-TB) financial protection policy: MDR-TB health insurance schemes, in Chhattisgarh state, India," Health Economics Review, Springer, vol. 8(1), pages 1-12, December.
  • Handle: RePEc:spr:hecrev:v:8:y:2018:i:1:d:10.1186_s13561-018-0187-5
    DOI: 10.1186/s13561-018-0187-5
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    1. Samia Laokri & Olivier Weil & Koiné Maxime Drabo & Sary Mathurin Dembelé & Benoît Kafando & Bruno Dujardin, 2013. "Removal of user fees no guarantee of universal health coverage: observations from Burkina Faso," ULB Institutional Repository 2013/153197, ULB -- Universite Libre de Bruxelles.
    2. Owen O'Donnell & Eddy van Doorslaer & Adam Wagstaff & Magnus Lindelow, 2008. "Analyzing Health Equity Using Household Survey Data : A Guide to Techniques and Their Implementation," World Bank Publications - Books, The World Bank Group, number 6896.
    3. Kutzin, Joseph, 2001. "A descriptive framework for country-level analysis of health care financing arrangements," Health Policy, Elsevier, vol. 56(3), pages 171-204, June.
    4. Ridde, Valéry, 2008. ""The problem of the worst-off is dealt with after all other issues": The equity and health policy implementation gap in Burkina Faso," Social Science & Medicine, Elsevier, vol. 66(6), pages 1368-1378, March.
    5. Srinath Satyanarayana & Sreenivas Achutan Nair & Sarabjit Singh Chadha & Roopa Shivashankar & Geetanjali Sharma & Subhash Yadav & Subrat Mohanty & Vishnuvardhan Kamineni & Nevin Charles Wilson & Antho, 2011. "From Where Are Tuberculosis Patients Accessing Treatment in India? Results from a Cross-Sectional Community Based Survey of 30 Districts," PLOS ONE, Public Library of Science, vol. 6(9), pages 1-8, September.
    6. Samia Laokri, 2017. "Collaborative Approaches and Policy Opportunities for Accelerated Progress toward Effective Disease Prevention, Care, and Control: Using the Case of Poverty Diseases to Explore Universal Access to Aff," ULB Institutional Repository 2013/266714, ULB -- Universite Libre de Bruxelles.
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