Factors Behind Rising Hysterectomies and its Consequences: Evidence from a Public Health Insurance Program in India

Abstract

This paper studies how publicly-financed health insurance can become counter-productive, ushering in unnecessary medical procedures with unintended health consequences. Using the fourth round of the National Family Health Survey, we show how a state-sponsored health insurance program providing tertiary care coverage led to a rise in hysterectomies. Our findings suggest that majority of these procedures were conducted in private hospitals, where medical providers might have financial incentives to over-treat and file more claims under the program. Furthermore, we find evidence that women who underwent a hysterectomy were more likely to experience adverse health outcomes. In particular, a hysterectomized women was more likely to report symptoms and seek treatment for chronic illnesses like cardiovascular, musculoskeletal and genitourinary disorders. We conduct several robustness checks to support our results. Our study motivates the need for clinical auditing and monitoring of health insurance programs without co-payments, especially for private medical facilities.

Keywords: supplier induced demand in healthcare, health insurance programs, India