Do National Health Insurance Programs for the Poor Improve the Relative Health Outcomes of the Poor? Evidence from India

Abstract

We study the relative health performance of the poor under national health insurance programs for the poor. In 2008, India introduced Rashtriya Swasthya Bima Yojana (RSBY), a national health insurance program for the poor. Using three waves of representative household data from the National Family Health Survey (1998-99, 2005-06, and 2015-16), and employing a difference-in-differences approach, we examine the relative maternal and child health service utilization and child mortality outcomes of the poor compared to the nonpoor. We also examine caste, religious, and spatial dimensions to the relative performance. We find that under the RSBY environment, the institutional and public hospital deliveries of the poor households are significantly higher by 8 and 11 percent, respectively, whereas their private hospital and the cesarean section deliveries are significantly lower by 3 percent and 4 percent, respectively. The poor from lower castes have lower institutional deliveries and worse birth outcomes than the poor from higher castes.

Note:
Funding Information: The authors declare that no funds, grants, or other support were received during the research and preparation of this manuscript.

Conflict of Interests: The authors have no relevant financial or non-financial interests to disclose.

Keywords: RSBY, maternal and child health, institutional deliveries, health insurance, India

JEL Classification: I13, I14, I18