Impact of Community-Based Health Insurance in Rural India on Self-Medication & Financial Protection of the Insured

Dror, D.M., Chakrarborty, A., Majumdar, A., Panda, P. and Koren, R. (2016) ‘Impact of community-based health insurance in rural India on self-medication & financial protection of the insured’, Indian Journal of Medical Research, 143(6), pp. 809–820. doi: 10.4103/0971-5916.192075.

13 Pages Posted: 14 Oct 2016

See all articles by David M. Dror

David M. Dror

Micro Insurance Academy (MIA)

Arpita Chakraborty

Oxford Policy Management India Pvt. Ltd

Atanu Majumdar

Micro Insurance Academy

Pradeep Panda

International Institute of Health Management Research

Ruth Koren

Tel Aviv University - Professor Sackler Faculty of Medicine

Date Written: June 1, 2016

Abstract

Background & objectives: The evidence-base of the impact of community-based health insurance (CBHI) on access to healthcare and financial protection in India is weak. We investigated the impact of CBHI in rural Uttar Pradesh and Bihar States of India on insured households’ self-medication and financial position.

Methods: Data originated from (i) household surveys, and (ii) the Management Information System of each CBHI. Study design was “staggered implementation” cluster randomized controlled trial with enrollment of one-third of the treatment group in each of the years 2011, 2012 and 2013. Around 40-50 per cent of the households that were offered to enroll joined. The benefits-packages covered outpatient care in all three locations and in-patient care in two locations. To overcome self-selection enrollment bias, we constructed comparable control and treatment groups using Kernel Propensity Score Matching (K-PSM). To quantify impact, both difference-in-difference (DiD), and conditional-DiD (combined K-PSM with DiD) were used to assess robustness of results.

Results: Post-intervention (2013), self-medication was less practiced by insured HHs. Fewer insured households than uninsured households reported borrowing to finance care for non-hospitalization events. Being insured for two years also improved the HH’s location along the income distribution, namely insured HHs were more likely to experience income quintile-upgrade in one location, and less likely to experience a quintile-downgrade in two locations.

Interpretation & conclusions: The realized benefits of insurance included better access to healthcare, reduced financial risks and improved economic mobility, suggesting that in our context health insurance creates welfare gains. These findings have implications for theoretical, ethical, policy and practice considerations.

Keywords: community-based health insurance, financial protection, hardship financing, rural India, self-medication

Suggested Citation

Dror, David M. and Chakraborty, Arpita and Majumdar, Atanu and Panda, Pradeep Kumar and Koren, Ruth, Impact of Community-Based Health Insurance in Rural India on Self-Medication & Financial Protection of the Insured (June 1, 2016). Dror, D.M., Chakrarborty, A., Majumdar, A., Panda, P. and Koren, R. (2016) ‘Impact of community-based health insurance in rural India on self-medication & financial protection of the insured’, Indian Journal of Medical Research, 143(6), pp. 809–820. doi: 10.4103/0971-5916.192075., Available at SSRN: https://ssrn.com/abstract=2852237

David M. Dror (Contact Author)

Micro Insurance Academy (MIA) ( email )

New Delhi, NCR
India
+41 78 790 6789 (Phone)

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Arpita Chakraborty

Oxford Policy Management India Pvt. Ltd ( email )

4/6, 1st Floor,
Siri Fort Institutional Area
New Delhi, ID Delhi 110019
India

Atanu Majumdar

Micro Insurance Academy ( email )

52-B, 1st floor
Okhla Industrial Estate, Phase III
New Delhi, 110020
India

Pradeep Kumar Panda

International Institute of Health Management Research ( email )

Plot No. 3, Sector – 18A
Dwarka, New Delhi 110075
India

Ruth Koren

Tel Aviv University - Professor Sackler Faculty of Medicine ( email )

Ramat Aviv
Tel-Aviv, 6997801
Israel

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