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The paper titled "Impact of Regulations on Key Metrics of Standalone Health Insurance Companies in India" is an attempt to gauge the performance of standalone health insurance companies in India. During 2022-23, the non-life insurance industry underwrote a total direct premium of 2.57 lakh crore in India registering a growth of 16.40 per cent from previous year. Out of which, 27 private sector insurers (including standalone health insurers) have underwritten 1.58 lakh crore as against 1.30 lakh crore in 2021-22 Several market dynamics are fuelling this growth, including strong distribution channels, democratic factors, government programs, and a favourable regulatory environment. Among various segments under non-life insurance business, health insurance business is the largest segment with a contribution of 38.02 percent (36.48 percent in 2021-22) of the total premium. Health Insurance Segment reported growth of 21.32 percent (26.27 percent growth in 2021-22) with the premium amounting to 97,633 crore from 80,502 crore in 2021-22. The net incurred claims under health insurance business of general and health insurers stood at 64,631 crore in 2022-23 reported an increase of about 2 percent from previous year. However, during the year 2021-22, the net loss of general and health insurance industry was ₹2,857 crore as against the net profit of ₹3,853 crore in 2020-21. Health Insurance Industry in general and Standalone Health Companies in particular are loss making on an accumulated basis which is the cause of concern. IRDAI regulations have a direct bearing on key metrics of standalone health insurance companies in India. This research is an attempt to decipher the impact of regulations on both top line and bottom line. [ABSTRACT FROM AUTHOR]

An essay is presented on the health insurance models in India. It provides an overview of the health insurance distribution channel and health insurance servicing in India as well as the country's innovative health insurance products such as indemnity and benefits products. It also explains the third-party (TPA) services and different modes of fraudulent health insurance claims as well as the power of insurers /TPAs to control health care costs and insurance regulatory landscape in the country.

The paper titled "Profitability matrix of Standalone Health Insurance Companies in India" is an attempt to gauge the performance of standalone health insurance companies in India. During 2022-23, the non-life insurance industry underwrote a total direct premium of 2.57 lakh crore in India registering a growth of 16.40 per cent from previous year. Out of which, 27 private sector insurers (including standalone health insurers) have underwritten 1.58 lakh crore as against 1.30 lakh crore in 2021-22 Several market dynamics are fuelling this growth, including strong distribution channels, democratic factors, government programs, and a favourable regulatory environment. Among various segments under non-life insurance business, health insurance business is the largest segment with a contribution of 38.02 percent (36.48 percent in 2021-22) of the total premium. Health Insurance Segment reported growth of 21.32 percent (26.27 percent growth in 2021-22) with the premium amounting to 97,633 crore from 80,502 crore in 2021-22. The net incurred claims under health insurance business of general and health insurers stood at 64,631 crore in 2022-23 reported an increase of about 2 percent from previous year. However, during the year 2021-22, the net loss of general and health insurance industry was 2,857 crore as against the net profit of 3,853 crore in 2020-21. Health Insurance Industry in general and Standalone Health Companies in particular are loss making on an accumulated basis which is the cause of concern. [ABSTRACT FROM AUTHOR]

Eliminating poverty by 2030 is the main target of Sustainable Development Goal 1(SDG1). India had an ambitious target of cutting down its poverty rate to 10.95% from 21.92%, by 2030. This review has the objective to consolidate the literature related to SDG1 in India, since 2015 and to identify futuristic research niches. This research focuses on the research questions of identifying the public policy initiatives in India for achieving SDG1 and the performance of various indicators of SDG1 in India. Forty‐one peer‐reviewed articles related to SDG1 in India are selected from the sources of Web of Science and consolidated the findings of these works of literature by using the indicators of NITI Aayog as the themes; described the empirical papers by highlighting the key variables and findings. This research had identified the health insurance penetration; slum rehabilitation and rejuvenation of Mahatma Gandhi National Rural Employment Guarantee Act (MGNREGA) are the futuristic areas for research. This paper contributes to the existing body of knowledge and recommends the key areas to be focused on achieving SDG1 in India. This review can help readers in understanding better methods of poverty eradication. High spirits are recommended from the implementing authorities to meet the objectives of indicators of poverty, better housing, health insurance penetration to households, and for the generation of employment and consumption by the scheme of MGNREGA. Moreover, a realistic picture of poverty eradication in India may be possible by using more indicators covering all the targets of SDG1. [ABSTRACT FROM AUTHOR]

In addition to government‐sponsored health insurance schemes (GSHIS), many microfinance institutions (MFIs) and community‐based organizations (CBOs) in India have started microinsurance health insurance schemes. These include health mutuals for the benefit of their members. This article explores these as an alternative health‐financing model in India. A literature search produced 926 relevant publications. After applying advanced search options and removing duplicates, abstracts of 324 papers were read and then 47 papers reviewed, and finally 29 were included in this review. Five key themes emerged: (1) "Health for all" arguments and opportunities in favour of micro health insurance schemes; (2) micro health insurance products; (3) impact of micro health insurance schemes; (4) systematic irregularities and regulatory framework; and (5) innovation. We also look at the emerging market patterns that will define micro health insurance products. Health mutuals can effectively provide mass health protection to the poor and not so poor through efficient business models, bespoke benefit packages and multiple payment plans. They can reduce financial vulnerability and improve health outcomes. While GSHIS can cover a substantial tranche of expected health‐related costs, the balance can be supplemented through innovative financial products that reduce financial risk. [ABSTRACT FROM AUTHOR]

Background: Publicly Funded Health Insurance Schemes (PFHIS) are intended to play a role in achieving Universal Health Coverage (UHC). In countries like India, PFHISs have low penetrance and provide limited coverage of services and of family members within households, which can mean that women lose out. Gender inequities in relation to financial risk protection are understudied. Given the emphasis being placed on achieving UHC for all in India, this paper examined intersecting gender inequalities and changes in PFHIS coverage in southern India, where its penetrance is greater and of longer duration. Data and methods: This study used the fourth (NFHS-4, 2015–16) and fifth (NFHS-5, 2019–21) rounds of India's National Family Health Survey for five southern states: namely, Andhra Pradesh, Karnataka, Kerala, Tamil Nadu, and Telangana. The World Health Organization's Health Equity Assessment Toolkit (HEAT) Plus and Stata were used to analyse PFHIS coverage disaggregated by seven dimensions of inequality. Ratios and differences for binary dimensions; Between Group Variance and Theil Index for unordered dimensions; Absolute and Relative Concentration Index (RCI) for ordered dimensions were computed separately for women and men. Results: Overall, PFHIS coverage increased significantly (p < 0.001) among women and men in Andhra Pradesh, and Kerala from NFHS-4 to NFHS-5. Overall, men had higher PFHIS coverage than women, especially in Andhra Pradesh, Tamil Nadu, and Telangana in both surveys. In both absolute and relative terms, PFHIS coverage was concentrated among older women and men across all states; age-related inequalities were higher among women than men in both surveys in Andhra Pradesh, Kerala, and Telengana. The magnitude of education-related inequalities was twice as high as among women in Telangana (RCINFHS-4: -12.23; RCINFHS-5: -9.98) and Andhra Pradesh (RCINFHS-4: -8.05; RCINFHS-5: -7.84) as compared to men in Telangana (RCINFHS-4: -5.58; RCINFHS-5: -2.30) and Andhra Pradesh (RCINFHS-4: -4.40; RCINFHS-5: -3.12) and these inequalities remained in NFHS-5, suggesting that lower education level women had greater coverage. In the latter survey, a high magnitude of wealth-related inequality was observed in women (RCINFHS-4: -15.78; RCINFHS-5: -14.36) and men (RCINFHS-4: -20.42; RCINFHS-5: -13.84) belonging to Kerala, whereas this inequality has decreased from NFHS-4 to NFHS-5., again suggestive of greater coverage among poorer populations. Caste-related inequalities were higher in women than men in both surveys, the magnitude of inequalities decreased between 2015–16 and 2019–20. Conclusions: We found gender inequalities in self-reported enrolment in southern states with long-standing PFHIS. Inequalities favoured the poor, uneducated and elderly, which is to some extend desirable when rolling out a PFHIS intended for harder to reach populations. However, religion and caste-based inequalities, while reducing, were still prevalent among women. If PFHIS are to truly offer financial risk protection, they must address the intersecting marginalization faced by women and men, while meeting eventual goals of risk pooling, indicated by high coverage and low inequality across population sub-groups. [ABSTRACT FROM AUTHOR]

This essay delves into the transformative role of technology in India's health insurance landscape. Beginning with the industry's evolution and challenges, like low penetration and insurance fraud, the study then examines the impact of technological advancements on the sector. Key technologies, such as AI, ML, blockchain, and data analytics, are discussed for their roles in risk assessment, claims processing, fraud detection, and enhancing customer experiences. The advent of telemedicine and its implications for policies are also scrutinized, supported by case studies from the Indian context. The paper projects future trends, addressing ethical concerns like data privacy and regulatory adaptations. In conclusion, the essay emphasizes technology's pivotal role in reshaping India's health insurance sector towards increased accessibility, efficiency, and customer-centricity, highlighting challenges and potential solutions. This comprehensive exploration aims to inform insurers, healthcare providers, technologists, and consumers about the industry's potential trajectory. [ABSTRACT FROM AUTHOR]

While Publicly Funded Health Insurance Schemes (PFHIS) can be an effective strategy to achieve Universal Health Coverage by offering financial protection, the extent to which they facilitate gender equity has been less explored. Women constitute one of the main vulnerable groups owing to a combination of health and economic vulnerabilities to access inpatient care services. Gender health equity requires that healthcare resources, such as PFHIS effectively reach women. This study investigates the gender differences in utilisation of Chief Ministers' Comprehensive Health Insurance Scheme (CMCHIS) by looking at a large volume of claims data covering 2012 to 2014 in the southern Indian state, Tamil Nadu. Previous studies indicate that women in the state had a higher hospitalisation rate than men and are entitled equally to CMCHIS. By disaggregating the data on number of beneficiaries, claim status, average and total claim value, type of procedures based on gender on a random selection of 230265 cases, the paper points out that women's utilization of CMCHIS is significantly lesser than men. Women constitute only 36% of all beneficiaries and received only half of the total claim value disbursed through the scheme. This pro-male bias was found to be statistically significant and consistent across the scheme years, age group and type of procedures. The study concludes that the gender inequity in utilization of CMCHIS is conspicuous and needs immediate attention from policy makers and administrators. With recent inclusion of COVID19 testing and treatment under PFHIS, the paper urges for further research lest more women are left behind. [ABSTRACT FROM AUTHOR]

This paper presents the results of a referendum-style contingent valuation survey conducted in one of the richest milking states of India. 200 households were surveyed to study the farmer’s preferences and choices for the health, breeding and insurance services. The objective of the survey was to assess the preference structure and the willingness of poor farmers to pay for veterinary health and insurance services. It is a comparative study between the existing situation and improved situation, that how the willingness to pay (WTP) will change if the quality of the health, breeding and insurance services will improve. The results show that farmers are willing to pay for assured access to veterinary services. Majority of the households value these services tremendously and are not looking for subsidies provided by the government institutions. It was noticed that farmer’s willingness to pay was much higher than the amount government institutions were presently charging for improved livestock support services, e.g. health and AI services. Though the coverage of Livestock insurance was low but it was found that farmers were ready to pay high amount of premium charges if the insurance services are easily available to the farmer’s door step with very less paper work and other formalities. Combining the findings of this survey with other closely related studies and the changing structure the input and output markets for livestock sector, the paper suggests specific policy measures to more effectively meet the expanding livestock services needs of poor livestock farmers. [ABSTRACT FROM AUTHOR]

Background: Health system in India is multifaceted and is influenced by a conglomeration of several factors. The diversity in the system coupled with disparities in the taxation system, makes it incredibly challenging to manage and consequently, the health system takes a toll. As a result, the infrastructure, as well as quality of healthcare, is in a poor state. Non-affordability of quality healthcare is another issue as many are not covered by insurance, and without it, they are susceptible to catastrophic health expenditures. This paper tries to explain the central role of these dual roadblocks: discrepancies in the taxation system and insufficient health insurance coverage as attributable factors of a number of issues in the Indian health system. Further, this paper analyses the health system of the Netherlands and draws ideas of implementing some ideas of the same in India. Although the two complexities threaten the healthcare system of the country, India can incorporate certain strategies that have yielded good results elsewhere for the betterment of the healthcare sector of the country [ABSTRACT FROM AUTHOR]

The unprecedented healthcare demand due to sudden outbreak of coronavirus disease 2019 (COVID-19) pandemic has almost collapsed the health care systems especially in the developing world. Given the disastrous outbreak of COVID-19 second wave in India, the health system of country was virtually at the brink of collapse. Therefore, to identify the factors that resulted into breakdown and the challenges, Indian healthcare system faced during the second wave of COVID-19 pandemic, this paper analysed the health system challenges in India and the way forward in accordance with the six building blocks of world health organization (WHO). Applying integrated review approach, we found that the factors such as poor infrastructure, inadequate financing, lack of transparency and poor healthcare management resulted into the overstretching of healthcare system in India. Although health system in India faced these challenges from the very beginning, but early lessons from first wave should have been capitalized to avert the much deeper crisis in the second wave of the pandemic. To sum-up given the likely future challenges of pandemic, while healthcare should be prioritized with adequate financing, strong capacitybuilding measures and integration of public and private sectors in India. Likewise fiscal stimulus, risk assessment, data availability and building of human resources chain are other key factors to be strengthened for mitigating the future healthcare crisis in country. [ABSTRACT FROM AUTHOR]

The cost of medical treatment is a sudden burden on the person’s budget. To avoid the risk, the health insurance becomes a safeguard. The scenario of nonlife insurance (specifically health insurance) penetration is not encouraging in India. The penetration of non-life insurance (ratio of premium to GDP) has increased from 0.80 per cent in 2013 to 0.94 per cent in 2019. Also, health insurance density is lower in India. The objective of this paper is to analyze the various factors affecting the decision of health insurance take up by household in India. The NSSO 75th round unit level data on health has been taken into consideration. Out of the 113,823 sample households, 113,821 were taken for this study. Multivariate logistic regression analysis is used to analyze the determinants of decision of taking up of health insurance. The results show that, there is a lower share of health insurance take up in rural area than urban. The social group wise difference is found in purchase of health insurance. The richest wealth quintile has greater probability of taking up health insurance than lower wealth quintile; female household head has greater probability of taking up of health insurance than male counterpart. Moreover, level of education affects positively, the health expenditure support from employer, support from government is negatively associated with the taking up of health insurance. Chronic ailments and hospitalization are positively and negatively related with health insurance being taken up respectively. This study suggests that, there is a need of health insurance related awareness and initial support from government to increase penetration of health insurance in India. [ABSTRACT FROM AUTHOR]

A thrust on insurance‐financed health systems may reduce Out‐of‐pocket health spending. But health insurance penetration among Indian elderly is abysmally low. In this context, the paper intends to examine the factors affecting demand for various types of insurances among Indian elderly. Data were drawn from 71st round (2014–15) "Key Consumption: Health" household survey data collected by National Sample Survey Organization (NSSO), Government of India. A total number of 27,245 older adults were selected for this study. In addition to basic descriptive statistics, we employ logistic regression models to conduct the econometric analysis. Socioeconomic, health‐related and contextual predictors are considered in this study. The results show that the probability of health insurance coverage among elderly significantly depends on income, education, disease types, caste, family size, and most importantly, social relationships. The underprivileged groups have higher likelihood to be covered by government‐funded insurance, while the older people with higher income and education, having spouses and less number of children, and residing in urban areas have a higher likelihood of purchasing private health insurance. The study identified the factors responsible for low demand for health insurance among elderly. The study suggests the expansion of private insurance network, especially, in the underserved rural areas, along with generating financial awareness among the elderly. The study also suggests an inclusive model of health insurance demand, which may be adopted by future empirical studies to find out the significant factors affecting health insurance demand. [ABSTRACT FROM AUTHOR]

Legislations for persons with disabilities emerged in the 1990s in India, providing them with rights and entitlements. Aligned with the UNCRPD, the Rights of Persons with Disabilities Act (2016) supports improved programmes and services. There are no exclusive policies for those with intellectual and developmental disabilities. Different government departments and non‐government organisations provide services including centrally sponsored programmes to persons with disabilities and enable them to exercise their rights. For example, rehabilitation and provision of aids and appliances lie with the Ministry of Social Justice and Empowerment, right to education is with the Ministry of Education, and, early intervention and health services and related supports are with the Ministry of Health. In India, non‐government organisations also play a vital role in health care services. In this paper, we discuss the existing health care systems including medical services in India for persons with disabilities with a specific focus on persons with intellectual and developmental disabilities. The discussion include how the system was evolved and what is in place today, the coverage, strengths, and limitations in the system. We have tried to provide a comprehensive description of existing policies, and practices of health care as well as the cultural influences with regard to health care for people with intellectual and developmental disabilities in India. [ABSTRACT FROM AUTHOR]

Quality health care is the essential need for all the citizens of the country. It forms the basis for equitable and sustainable economic development. India has made significant progress in basic health care over the past few decades. However, still most people do not have access to essential health care services. Health insurance is very important for every citizen, especially in India, where there is a large rural population. As everyone cannot afford private Health insurance coverage, so government must take initiatives to provide health insurance coverage to poor people. Government of India has been taking initiatives to provide financial assistance for health care costs for vulnerable and needy families. Rastriya Swasthya Bima Yojana (RSBY) was launched in the year 2008, but was not very successful. Prime Recently, Ayushman Bharat Jana Arogya Yojana (PMJAY) was launched on 23rd September 2018. It provides health insurance cover of Rs. 5 lakhs per year, per family for secondary and tertiary care hospitalization to more than 10.74 crore poor and vulnerable families. Ayushman Bharat PMJAY card holders can claim cashless services at all the empanelled hospitals or at the private hospitals (approximately 20,000 plus) those have registered to offer PMJAY. The total number of Ayushman Bharat Cards issued till 21st March 2022 are 17,86,97,235 and Hospital admissions under PMJAY as of 21st March 2022 since launch are 3,11,27,750. Ayushman Bharat PMJAY has shown a good progress since its launch. It is a successful health insurance scheme till now. This paper studies about reasons of perceived failure of Rastriya Swasthya Bima Yojana (RSBY), Introduction of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY), its features, coverages and benefits, the factors behind the success of Ayushman Bharat PMJAY scheme, its challenges and about the future of the scheme. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to examine the dynamic nature of the catastrophic health expenditure (CHE) on remittances receiving households between 2005 and 2012 in India. Design/methodology/approach: The study adopted Xu's (2005) definition of catastrophic health-care expenditure. And also used binary logistic regression to examine the effects of remittances being received on CHE in households across India. The data were drawn from the two rounds of the India Human Development Survey conducted by the University of Maryland, the USA, and the National Council of Applied Economic Research, New Delhi, India. Findings: The results show that the percentage of households received remittances, and that the amount of remittances received has substantially increased during 2005 and 2012, though variation is evident by socioeconomic and demographic characteristics of the household. Apparently, the variation (percentage of households received remittances) is more pronounced for factors such as household size, number of 60+ elderly, sectors and by regions. Household's catastrophic health spending and remittances being received show a statistically significant association. Households which received remittances during both the time showed the lowest likelihood (AOR:0.82; p-value < 0.10; 95% CI:0.64–1.03) to experience catastrophic health spending. Originality/value: The paper identified the research gap to examine the occurrence of catastrophic health spending by remittances receiving status of the household using a novel panel data set. [ABSTRACT FROM AUTHOR]

The Indian insurance is expected to grow to a size of USD 280 billion by the year 2020. The premium income for the life insurance segment reached USD 64.92 billion in FY17. The premium income for the general and health insurance segments reached USD 19.88 billion. This has increased the operational costs of both public and private companies. Due to the nature of the insurance industry, traditional cost-cutting measures may not be effective due to various stakeholders in the insurance industry. The Indian insurance industry has been introducing new products like catastrophe bonds in order to improve risk management. This paper aims to explore the use of the emerging technology, Blockchain, In order to reduce cost and improve risk management functions. The paper is going to focus primarily on blockchain technology and its potential to transform the industry through changes in data collection and dissemination of insurance related data. This primary focus on blockchain will be maintained when exploring the use of other emerging technologies like the Internet of things and AI in the process of augmenting the use of blockchain technology as a part of insuretech. [ABSTRACT FROM AUTHOR]

Financing is an important aspect of any program for successful transformation. Financial commitment of government is considered to be the highest form of commitment for successful work. Without budgetary provision, no program can achieve the desired target. The role of health financing of central government, international donor agencies, provincial government, and local bodies have been identified. The paper focused on monitoring and evaluation mechanisms for health financing in the context of recent developments. Health financing models have been discussed to gain an understanding about relation of financing and overall healthcare development. The search engines like PubMed, Scopus, Web of Sciences, and jstor (journal storage) were consulted to unearth the mechanism of health finances for development of good health. The paper put forth various themes and sub-themes according to financial implications on health structure of India. All healthcare programs need a continuous stream of resources like medicine, workforce, physical infrastructure, monitoring, and evaluation to achieve good health. Whereas, different stakeholders also need financial support to evolve with great vigour and vivacity. There is a pressing need to infuse financial resources into public health system for achievement of universal health care rather than incremental growth in traditional financial processes spreading over several decades. The specific roles and responsibilities of central, provincial, local governments, and international donors have to be delineated to expedite resource mobilisation. However, while implementing programs, there should be coordination among all the stakeholders. [ABSTRACT FROM AUTHOR]

This paper explores the dynamics of access under the state-funded universal health insurance scheme in Chhattisgarh, India, and specifically the relationship between choice, affordability and acceptability. A qualitative case study of patients from the slums of Raipur City incurring significant heath expenditure despite using insurance, was conducted, examining the way patients and their families sought to navigate and negotiate hospitalisation under the scheme. Eight purposefully selected ('revelatory') instances of patients (and their families) utilising private hospitals are presented. Patients and their family exercised their agency to the extent that they could. Negotiations on payments took place at every stage, from admission to post-hospitalisation. Once admitted, however, families rapidly lost the initiative, and faced mounting costs, and increasingly harsh interactions with providers. The paper analyses how these outcomes were produced by a combination of failures of key regulatory mechanisms (notably the 'smart card'), dominant norms of care as a market transaction (rather than a right), and wider cultural acceptance of illegal informal healthcare payments. The unfavourable normative and cultural context of (especially) private sector provisioning in India needs to be recognised by policy makers seeking to ensure financial risk protection through publicly financed health insurance. [ABSTRACT FROM AUTHOR]

Background: Government-sponsored health insurance schemes (GSHIS) aim to improve access to and utilization of healthcare services and offer financial protection to the population. India's Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) is one such GSHIS. This paper aims to understand how the processes put in place to manage hospital-based transactions, from the time a beneficiary arrives at the hospital to discharge are being implemented in PM-JAY and how to improve them to strengthen the scheme's operation.Methods: Guidelines were reviewed for the processes associated with hospital-based transactions, namely, beneficiary authentication, treatment package selection, preauthorization, discharge, and claims payments. Across 14 hospitals in Gujarat and Madhya Pradesh states, the above-mentioned processes were observed, and using a semi-structured interview guide fifty-three respondents were interviewed. The study was carried out from March 2019 to August 2019.Results: Average turn-around time for claim reimbursement is two to six times higher than that proposed in guidelines and tender. As opposed to the guidelines, beneficiaries are incurring out-of-pocket expenditure while availing healthcare services. The training provided to the front-line workers is software-centric. Hospital-based processes are relatively more efficient in hospitals where frontline workers have a medical/paramedical/managerial background.Conclusions: There is a need to broaden capacity-building efforts from enabling frontline staff to operate the scheme's IT platform to developing the technical, managerial, and leadership skills required for them. At the hospital level, an empowered frontline worker is the key to efficient hospital-based processes. There is a need to streamline back-end processes to eliminate the causes for delay in the processing of claim payment requests. For policymakers, the most important and urgent need is to reduce out-of-pocket expenses. To that end, there is a need to both revisit and streamline the existing guidelines and ensure adherence to the guidelines. [ABSTRACT FROM AUTHOR]

Sudden health shocks may be devastating if their consequences are transferred to human capital formation of children, especially in families that are unable to access affordable healthcare. As such, access to health insurance may play a role in determining schooling decisions. I examine the impact of India's national health insurance scheme (RSBY) on gender differences in school enrolments in this paper. Employing difference‐in‐differences and triple differences approaches, I find that RSBY reduces the gender gap in school enrolments. Therefore, while RSBY was implemented with the aim of reducing financial burden for the poor, I find evidence that it has unintended positive consequences for girls in particular. [ABSTRACT FROM AUTHOR]

Purpose Recently, the Indian government launched health insurance schemes for the poor both to protect them from high health spending and to improve access to high-quality health services. This article aims to review the potentials of health insurance interventions in order to improve access to quality care in India based on experiences of community health insurance schemes. Data sources PubMed, Ovid MEDLINE (R), All EBM Reviews, CSA Sociological Abstracts, CSA Social Service Abstracts, EconLit, Science Direct, the ISI Web of Knowledge, Social Science Research Network and databases of research centers were searched up to September 2010. An Internet search was executed. Study selection One thousand hundred and thirty-three papers were assessed for inclusion and exclusion criteria. Twenty-five papers were selected providing information on eight schemes. Data extraction A realist review was performed using Hirschman's exit-voice theory: mechanisms to improve exit strategies (financial assets and infrastructure) and strengthen patient's long voice route (quality management) and short voice route (patient pressure). Results of data synthesis All schemes use a mix of measures to improve exit strategies and the long voice route. Most mechanisms are not effective in reality. Schemes that focus on the patients’ bargaining position at the patient-provider interface seem to improve access to quality care. Conclusion Top-down health insurance interventions with focus on exit strategies will not work out fully in the Indian context. Government must actively facilitate the potential of CHI schemes to emancipate the target group so that they may transform from mere passive beneficiaries into active participants in their health. [ABSTRACT FROM PUBLISHER]

Background: This paper examines two state-led public-private demand-side financial support programs aiming to raise hospital delivery rates in two neighbouring Indian states-Gujarat and Madhya Pradesh. The national Janani Suraksha Yojana (JSY) was complemented with a public-private partnership program Janani Sahayogi Yojana (JSaY) in Madhya Pradesh in which private obstetricians were paid to deliver poor women. A higher amount was paid for caesarean sections (CS) than for vaginal deliveries (VD). In Gujarat state, the state program Chiranjeevi Yojana (CY) paid private obstetricians a fixed amount for a block 100 deliveries irrespective of delivery mode. The two systems thus offered an opportunity to observe the influence of supplier-induced demand (SID) from opposite incentives related to delivery mode. Methods: The data from the two programs was sourced from the Departments of Health and Family Welfare, Governments of Gujarat and Madhya Pradesh, India. Results: In JSaY program the CS rate increased from 26.6 % (2007-2008) to 40.7 % (2010-2011), against the background rate for CS in Madhya Pradesh, of only 4.9 % (2004-2006). Meanwhile in CY program in Gujarat, the CS rate decreased to 4.3 % (2010-2011) against a background CS rate of 8.1 % (2004-2006). Conclusions: The findings from India are unique in that they not only point to a significant impact from the introduction of the financial incentives but also how disincentives have an inverse impact on the choice of delivery method. [ABSTRACT FROM AUTHOR]

The Pradhan Mantri Gram Sadak Yojana (PMGSY) programme of India provides new road connectivity for unconnected habitations with a population of at least 500. This paper evaluates the causal effect of the new road connectivity on the healthcare benefits accrued to the previously unconnected village households, specifically the pregnancy care and contraceptive use, awareness and hygiene, and social interaction. The nonparametric fuzzy regression discontinuity design (FRDD) is applied to the data derived from the 2007-2008 District Level Household Survey (DLHS-3) and the Socioeconomic High-Resolution RuralUrban Geographic Platform for India (SHRUG) data. The FRDD estimates show that in the treatment villages, more women seek antenatal care, have delivery conducted in hospitals and use modern contraceptive methods. In the villages newly connected with roads, awareness of government health care programmes like prevention of sex selection and female foeticide, treat water and take health insurance coverage has increased. The provision of all-weather roads to unconnected villages is also more likely to impact social interaction and more participation in women’s selfhelp groups, and village assembly takes important decisions on preventive healthcare. The Pradhan Mantri Gram Sadak Yojana (PMGSY) programme of India provides new road connectivity for unconnected habitations with a population of at least 500. This paper evaluates the causal effect of the new road connectivity on the healthcare benefits accrued to the previously unconnected village households, specifically the pregnancy care and contraceptive use, awareness and hygiene, and social interaction. The nonparametric fuzzy regression discontinuity design (FRDD) is applied to the data derived from the 2007-2008 District Level Household Survey (DLHS-3) and the Socioeconomic High-Resolution RuralUrban Geographic Platform for India (SHRUG) data. The FRDD estimates show that in the treatment villages, more women seek antenatal care, have delivery conducted in hospitals and use modern contraceptive methods. In the villages newly connected with roads, awareness of government health care programmes like prevention of sex selection and female foeticide, treat water and take health insurance coverage has increased. The provision of all-weather roads to unconnected villages is also more likely to impact social interaction and more participation in women’s selfhelp groups, and village assembly takes important decisions on preventive healthcare. [ABSTRACT FROM AUTHOR]

Public investment on health in India is very low (it stands out at 1.5 per cent of GDP in 2018- 19 as per Budget Estimates), which results in high out-of-pocket (OOP) expenditure on health. High OOP expenditure has a catastrophic impact on the household/ individual wellbeing as it disrupts the customary standard of living of these households. In order to protect these households from financial catastrophe, various state governments as well as the union government introduced various health insurance schemes, the efficacy of which is yet to be ascertained. This paper attempts to analyse the effectiveness of insurance schemes (both private and public) in reducing the financial burden of health shocks. The study adopted the two-step Heckman-Selection Method to examine the determinants of catastrophic health expenditure and the results showed that insurance was one of the major determinants of catastrophic health expenditure. Further, the study also showed that public health insurance was more equitable in nature. Therefore, the government should further increase its thrust towards health for all approaches and should bring them under the safety net. [ABSTRACT FROM AUTHOR]

Background and Objective Healthcare in India is not a primary right, but is only a constitutional obligation of the State which refers only to a State's duty regarding improvement of primary health amongst its other duties.1 Art 39 : Specifies certain principles of policy to be followed by the State (e) That the health and strength of workers, men and women, and the tender age of children are not abused and that citizens are not forced by economic necessity to enter avocations unsuited to their age or strength; (f) That children are given opportunities and facilities to develop in a healthy manner and in conditions of freedom and dignity and that childhood and youth are protected against exploitation and against moral and material abandonment. Art. 47: Specifies duty of the State to raise the level of nutrition and the standard of living and to improve public health. The State shall regard the raising of the level of nutrition and the standard of living of its people and the improvement of public health as among its primary duties and, in particular, the State shall endeavour to bring about prohibition of the consumption except for medicinal purpose of intoxicating drinks and of drugs which are injurious to health. As per WHO's World Health Statistics of 2007, India ranked 184 among 191 countries in terms of public expenditure on health as a percent of GDP. It is surprising to that despite of all advancements and progress made in the last one decade, public spending on health as a percent of GDP in India has stagnated in the past two decades, from 1990-91 to 2009-10, varying from 0.9 to 1.2 percent of GDP. While public spending on healthcare is low, the out of pocket (OOP) expenditure by individuals, contributes majorly to the expenditure on healthcare, 75% Out of Pocket (OOP) spending. 40% of hospitalised are pushed below poverty line or into lifelong debt due to lack of financial planning. In 2007, private spending in India constituted nearly 74 percent of the total spending on health drastically less in comparison to some other countries. Of all the risks facing poor households, health risks pose the greatest threat to their lives and livelihoods. A health shock adds health expenditures to the burden of the poor. Even a minor health shock can cause a major impact on poor persons' ability to work and curtail their earning capacity. Moreover, given the strong link between health and income at low income levels, a health shock usually affects the poor the most. Thus, in a system that gets dominated by outof- pocket expenditures, the poorer pay disproportionately more on health as compared to their earnings than the rich and this leads to a vicious cycle of ill health as access to healthcare is governed by an individual's ability to pay. The other challenge that India faces today, is Demographic Transition with Low Birth Rate & Low Death Rate. The fact here is that the life expectancy of the people is increasing and, as a result, the number of ageing or elderly population too is proportionately increasing. Demographic Transition has further led to an Epidemiological transition characterized, as a shift away from diseases of famine to receding pandemics to an age of generative and manmade diseases. 3 fundamental changes have taken place with the above transition, namely: 1. Mortality decline due to infectious diseases, injuries. and mental illness. 2. Shift of the burden of death and diseases from the younger to the older groups. 3. Change in health profile from one dominated by death to one dominated by morbidity. In such a scenario, Curative Treatment becomes the mantra to ensure better Health Indices. However, with the polarization being on Curative treatment, the Healthcare Costs have escalated with a Medical Inflation Index hovering around 10-12% YoY (year on year), in addition to this, with Medical Advances, the cost of treatment further escalates. Most of the Public Healthcare in India, in the form of centrally funded schemes, focuses on Preventive & Promotive Care not taking into account, Curative Care. Due to defocused effort on the Curative Cure, healthcare in India has currently become one of the most unregulated sectors with expenses increasing disproportionately. Moreover, even in Public Healthcare units, the curative care is not "all free", with one fourth of the expenses being out of pocket. These factors affect the informal sector of the country who are not protected by any of the financing or government supported schemes like ESIC, CGHS, etc. To counter the above, two broad methods have been proposed as alternatives on optimal resource utilization: Cost Containment l Privatization Community Participation l Cost Sharing l User Financing l Health Insurance Health Insurance has been useful as a tool for augmenting financial resources available for care, and as a means of better linking health demand to the provision of service. Many states have now implemented Health Insurance Schemes to cover the aspects of Curative Care. Most of the State/Central Projects which are currently running, work on the concept of Horizontal Cross Subsidization as opposed to Mediclaim which tends to be run as Vertical Cross Subsidization. The Cross Subsidization is also due to the Risk Solidarity in the schemes (a blend of both high and low risk individuals). Horizontal: Within the economic group Vertical: Across various groups (economic, age, gender, etc.) These schemes are also common on the principle of determining the Premiums. These are based on the Community rating with or without a premise of Experience rating. On the other hand, there are few states where Self Funded Schemes work very well, under the Governance of the State Govt. some examples being the Mukhyamantri Amrutum Yojana in Gujarat, Yeshasvini Cooperative Farmers Healthcare scheme in Karnataka (these schemes may be partly funded by the Government and partly by the beneficiaries). Design and Methods This paper is a comparative analysis of select mass health insurance schemes, both successful & unsuccessful, which have been implemented in India in the past few years. The Scope of the paper will be Comparative Analysis of the following schemes: 1. Rashtriya Swasthya Bima Yojana, Pan India 2. Rajiv Arogyri Scheme, Andhra Pradesh 3. Chief Minister's Comprehensive Health Insurance Scheme, Tamil Nadu 4. Bhai Ghanhya Sehat Sewa Scheme, Punjab 5. National Trust 6. Weavers' & Artisans' & Sericulture 7. Swarnajayanti Aarogya Bima Yojana, Goa 8. Mukhyamantri Amrutum Yojana, Gujarat The Stakeholders for these Schemes share a common relationship: 1. Source of funds: Government and beneficiaries in some instances 2. Beneficiaries- Population below poverty line or a community of similar socio-economic status 3. Fund pooling is often done by an Insurance company 4. Risk Management- Trust/society established by government 5. Service providers: Network Hospitals 6. Implementing Agency: Third Party Administrators These schemes differentiated from each other broadly on the basis of the following parameters: 1. Source of funding: State funded/ Insurance/Centre funded 2. Scope of coverage : Primary or Secondary & Tertiary coverage 3. Grading criteria for hospitals 4. Integration of Hospital Scores & rates for procedures 5. Provider Tendering for Procedures 6. Administration & Implementation of the schemes The various differentiators will be studied and documented as per observations for the purpose of learning what was best implemented, thought of and successful idea for bringing in the latest and quality care to the members of society who need it the most. Results There did not seem to be one scheme which allowed replication Pan India for better Health Indices, some being complementary to the others. This is so because: 1. Selection of packages and disease coverage is a factor that gets determined by the epidemiological trends and characteristics of the target community 2. Provider trends are dependent on local practices and culture. 3. Implementing States have different strategies, cultural practices and political environment. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to draw theoretical insight from Sen's capability-approach and attempts to examine the effectiveness of health-insurance-schemes in reducing out-of-pocket-expenditure (OOPE) and catastrophic-health-expenditure (CHE) in India. Design/methodology/approach: Data were extracted from the National-Sample-Survey-Organization, 71st round on Health-2014. Generalized-linear-regression-model was used to investigate the impact of social-protection-schemes on OOPE and CHE. Findings: A notable segment of the Indian population is still not covered under any health-insurance-schemes. The majority of the insured population was covered by publicly-financed-health-insurance-schemes (PFHIs), with a trivial-share of private-insurance. Households from 16–59 age-group, urban, literate, richest, southern-regions, using private-facilities and having ear and skin ailments have reported higher insurance coverage. Reimbursement was higher among elderly, literates, middle-class, central-regions, using private-facilities/insurance and for infections. Access to PFHIs significantly reduces the risk of OOPE and CHE. Unavailability of reimbursement exposes the population to a higher risk of CHE. Research limitations/implications: Being a study based on secondary data sources, its applicability may vary as per the other social indicators. Practical implications: Extending insurance-coverage alone cannot answer the widespread inequalities in health care. Rather, an efficiently managed reimbursement-mechanism could condense OOPE and CHE by enhancing the capability of the population to confront the undue financial burden. Social implications: Extending the health-insurance-coverage to the entire population requires a better understanding of the underlying-dynamics and health-care needs and must make health-care affordable by enhancing the overall capability. Originality/value: This research brings a theoretical and conceptual analysis for improving the health-insurance coverage among the community as a public health strategy. [ABSTRACT FROM AUTHOR]

This paper highlights how privatization in healthcare is being promoted and its further growth facilitated through the adoption of neoliberal policies in India. The approach to financing healthcare has been shifting from public provisioning to tax-funded health insurance merely to achieve health coverage. The idea of the strategic purchasing of care from private providers promoted through insurance seems likely to aggravate the crisis in access and healthcare delivery. Such a crisis will escalate costs and promote concentration and monopolies in the healthcare market. Under the recently promoted neoliberal policy, India is compromising the goal of comprehensive provision of public health services, which is essential for creating a healthier society. [ABSTRACT FROM AUTHOR]

Indian insurance industry has immense growth potential. One important factor that inhibits growth and development of the industry is increasing Insurance Fraud. Since there are no strong penal measures are available in Indian Penal Code, the fraudsters are committing frauds all across the country, especially in rural and semi-urban areas. According to one estimate, the volume of insurance fraud in India is about Rs. 40,000 crore. There are two types of people who commit frauds. One category is known as "Opportunity Fraudster" while the other type is "Professional Fraudster". The opportunity fraudsters are normally law abiding people but do not mind claiming more than they should as they believe it ignorantly that insurers do not stand to lose, when "small" frauds are committed. Apart from traditional methods of Internal Auditing and Investigation of Claims, the insurers are using Artificial Intelligence based Machine Learning Algorithms to prevent and detect frauds. These are not too costly as compared to Utilities that the insurers can get out of these measures. In this paper, an attempt has been made to list the efforts made by insurers to manage Insurance Fraud to the extent possible. [ABSTRACT FROM AUTHOR]

Several countries with diverse health systems have achieved universalization (UHC). The trajectory towards universal coverage almost always has three typical features: (i) a political process driven by a range of regulatory changes to simplify access; (ii) an increase in health spending; (iii) an increase in the share of pooled spending rather than paid out-of-pocket. Therefore, a study was undertaken to understand the extent of the provider-purchaser relationship of governments to achieve UHC while reforming healthcare. The present paper focuses on extensive secondary research across countries and evaluates the experiences of select developed and developing economies with India's experiments on- Financing mechanisms, management arrangements, governance and health outcomes; to offer a comparison of practices and their impact. While Italy, the UK, Germany, Australia, Japan, Canada and most recently China are countries that have achieved UHC; countries like USA and Brazil are on the verge of achieving UHC. These nine countries represent the entire spectrum of pure purchasing models, mixed and pure provisioning models to help us leverage from their experience. All countries that have attained UHC have a well-defined package of services that the government commits to fund and provide for (both public and private). Additionalities around wellness and cosmetic care is managed through supplementary insurance. Overall funding is through an autonomous body, at arm's length of government; primarily to govern and manage the state's health priorities. And the government purely behaves as a regulator setting policy and giving directions to the providers. However, ensuring the sustenance of such a mixed model requires; (i) a well-regulated ecosystem that thrives on evidence, (ii) the governments must clearly define the role/s of each stakeholder and hold them accountable for their deliverables in attaining UHC. [ABSTRACT FROM AUTHOR]

Purpose – The national health policy should strive towards achieving the concept of "healthcare for all" conceptualized by the World Health Organization (WHO) through health insurance scheme. The purpose of this paper is to identify and discuss the various gaps affecting the health care systems and to evolve strategic issues in health care in India through an exploratory survey. Design/methodology/approach – The main thrust is to analyze the problems of India's health care system and review of related literature, to identify the areas in the field of healthcare and health insurance which are unexplored or need to be tapped. This evaluation would give ample data to reinforce these areas and would lead us ultimately to the pre-set target of WHO. Findings – India's march to prosperity faces a serious risk of slowing down due to the main reason – lack of proper access to health care due to the absence of a well laid out public policy. Therefore, the key stakeholders of the health insurance industry jointly need to build a robust health insurance system and help to bridge the gap that exists in reaching quality healthcare in India. A review of the health policy for modifications and to implement it successfully through health insurance without road blocks is called for. Practical implications – The results of this study, it is hoped, will outline equity in health care, which matters to every Indian citizen and how it can be achieved in India. Originality/value – This paper suggests the adoption of an approach of management science called the gaps model of service quality in dealing with India's healthcare system problems, a new indicator aimed at assessment of the deficit in access to health services through a structured integrated way. The strategy takes account of the significant gaps identified to suggest new pragmatic methods to close the gaps. [ABSTRACT FROM AUTHOR]

This paper examines the everyday experiences and perspectives of Muslim Ansaris (weavers) in urban north India with respect to the 'welfare state'. The case of a recent health insurance scheme, initiated by the Indian government, constitutes the paper's focus. Narratives around the scheme expressed by residents in a majority Muslim mohalla (neighbourhood) in Varanasi illustrate the ways in which the state's presence was more often experienced through its perceived absence and inaccessibility. But even whilst such experiences represented broader patterns of neglect, locally interpreted as the upshot of being India's largest religious minority, this community was not stricken by a sense of absolute alienation and nor did individual or collective actions exhibit outright disaffection towards the state. More appropriately, 'defensive agencies' informed by degrees of pragmatism, acceptance and resilience, were articulated in an effort to protect, as well as improve the future capacities and ambitions of the neighbourhood residents where the state had seemingly failed. The paper concludes however with a word of caution about celebrating such agency, and reflects on the potential for transformative politics by Muslims in urban India. [ABSTRACT FROM AUTHOR]

Ensuring healthy lives and promoting the wellbeing at all stages is necessary for making the process of sustainable development into reality. However, Poor accessibility to healthcare services especially in developing countries acts as a barrier towards this. Every year, Insufficient Government expenditure on healthcare services resulting heavy out of pocket healthcare expenses push people into vulnerable situation. In such a situation, the role of health insurance becomes very significant. Considering all these factors, in country like India, a well organised health insurance market has been gradually evolved over the years. But it is not sufficient because many people are still left untreated and even approximately 25% people are pushed below poverty line by catastrophic impact of out of pocket healthcare expenditure every year. Factors like lack of awareness, policy loopholes, poor infrastructure etc. are mainly responsible for the poor performance of the health insurance market in India. Through this paper, it is tried throw light on all these phenomena comprehensively along with some measures to correct the lacunas. [ABSTRACT FROM AUTHOR]

Background: Universal health coverage (UHC) has provided the impetus for the introduction of publicly funded health insurance (PFHI) schemes in the mixed health systems of India and many other low- and middle-income countries. There is a need for a holistic understanding of the pathways of impact of PFHI schemes, including their role in promoting equity of access.Methods: This paper applies an equity-oriented evaluation framework to assess the impacts of PFHI schemes in Chhattisgarh State by synthesising literature from various sources and highlighting knowledge gaps. Data were collected from an extensive review of publications on PFHI schemes in Chhattisgarh since 2009, including empirical studies from the first author's PhD and grey literature such as programme evaluation reports, media articles and civil society campaign documents. The framework was constructed using concepts and frameworks from the health policy and systems research literature on UHC, access and health system building blocks, and is underpinned by the values of equity, human rights and the right to health.Results: The analysis finds that evidence of equitable enrolment in Chhattisgarh's PFHI scheme may mask many other inequities. Firstly, equitable enrolment does not automatically lead to the acceptability of the scheme for the poor or to equity in utilisation. Utilisation, especially in the private sector, is skewed towards the areas that have the least health and social need. Secondly, related to this, resource allocation patterns under PFHI deepen the 'infrastructure inequality trap', with resources being effectively transferred from tribal and vulnerable to 'better-off' areas and from the public to the private sector. Thirdly, PFHI fails in its fundamental objective of effective financial protection. Technological innovations, such as the biometric smart card and billing systems, have not provided the necessary safeguards nor led to greater accountability.Conclusion: The study shows that development of PFHI schemes, within the context of wider neoliberal policies promoting private sector provisioning, has negative consequences for health equity and access. More research is needed on key knowledge gaps related to the impact of PFHI schemes on health systems. An over-reliance on and rapid expansion of PFHI schemes in India is unlikely to achieve UHC. [ABSTRACT FROM AUTHOR]

The speedy progress of trade in Global Health Services is limited by legal barrier. Advances in technology and cross-border movement of people and health services form legal ambiguities and uncertainties for businesses and consumers involved in transnational medical malpractice disputes. This requires for a uniform means of redress which is more flexible and predictable as compared to litigation in a court room. Therefore, the voluntary, flexible and legally binding nature of arbitration agreements across jurisdictions make this form of dispute resolution efficient and adaptive to changes in the health services industry. With careful making of an approach that accounts for arbitration cost, reasonable recovery amount and complementary mechanisms such as no-fault compensation, international arbitration of medical malpractice disputes will change the legal risks borne by businesses and consumers more fairly and efficiently. This paper argue that most medical disputes are better resolved by alternative dispute resolution mechanisms which will contribute in improving patient safety by encouraging candid and comprehensive reporting of risks. It also argues that medical disputes and patient safety needs to be viewed through a new lens, namely patient autonomy. It discusses the scope of India flourishing in the field of Medical Tourism and also the challenges faced by the foreign patients and the scope of Arbitration in amicably resolving the medical disputes in a cost effective and in a swift manner. [ABSTRACT FROM AUTHOR]

India is one of the important countries in world trade as far as the service sector is concerned. The health insurance sector continues to be one of the most dynamic and fast-evolving constituents of the Indian Insurance Industry. This paper makes an attempt to examine the expectations and perceptions of policyholders regarding health insurance service quality of public and private sector general insurance companies. The data is collected from 800 health insurance policyholders in Greater Mumbai region, Maharashtra, India using simple random sampling technique. Structured questionnaire is used for collecting primary data. Secondary data is collected from journals, books, websites etc. The top 8 general insurance companies including the public and private sector, operating in India, was selected. The study is based on the SERQUAL model developed by Parasuraman et al. The study is based on five factors of health insurance service quality viz; Reliability, Empathy, Access, Responsiveness and Tangibles. Statistical tools used in the study are Parametric Paired 't' test, mean and standard deviation. The study revealed that there is a significant difference in the expectations and perceptions of policyholders regarding Health Insurance Service Quality factors (Reliability, Empathy, Access, Responsiveness and Tangibles) in both public and private sector general insurance companies. Also, all differences are positive, which denotes that customer's expectations exceed customer's perception. The general insurance company should try to bridge the gap between expectations and perceptions of the customers to satisfy the customers and to retain them. Customer satisfaction depends on the agreement between expectations and perceptions of service quality. [ABSTRACT FROM AUTHOR]

Health insurance is the emerging service sector in India. India is a growing economy, people in urban and rural areas are now days more educated, health conscious, rise in their living standard and need of quality healthcare leads to need of health Insurance. Health insurance in India are provided by government sector as well as private sector players. After deregulation many private sector Insurance companies entered in the insurance market and offer a wide range of innovative products to the consumers. Liberalization also opened the doors for foreign player to enter in health insurance sector. As a result the scope of Health insurance sector is getting wider. Government of India is also focusing on the improvement of health care and health insurance services. Recent government envisioned health insurance for each citizen. It has planned to cover the medical treatments of the entire population like free drugs, insurance for serious ailments under Universal Health Insurance called National Health Assurance Mission. Growing middle class, educated youth, awareness of need for protection against lifestyle disease, tax benefits are the factors which are giving growth opportunities to health insurance sector to become fastest growing non-life insurance segment. These opportunities are facilitating market players to expand their business and competitiveness in the market. Companies are becoming more customer centric, drive down cost, using new technology etc which are helping them to grow. But there are some structural problems faced by the companies like high claim ratios, less understanding of product, changing need of customers etc. which emphasize companies to innovate products on all fronts. This paper is an attempt to study the present health Insurance scenario, opportunities and challenges of Health Insurance Companies in India. [ABSTRACT FROM AUTHOR]

The healthcare industry worldwide is undergoing a radical transformation. An enthusiastic healthcare system of the Government of India (GOI) continually tries to tackle numerous challenges facing the system. The Rashtriya Swasthya Bima Yojana (RSBY) program has provided secondary level healthcare facilities to more than 36 million families across most states in India. This particular health insurance initiative was taken by the GOI with the purpose to safeguard the pitiable or marginalized Indian population or those households who are facing economic risks due to hospitalization and their everyday expenditures. RSBY provides affordable and accessible healthcare services along with insurance coverage for secondary care. However, it is limited to inpatient treatment or hospitalization. For outpatient coverage many strategies have been applied but low enrolment is still an existing flaw under this streamer. The present paper discusses various features of RSBY, outpatient projects undertook, and various obstacles that can be removed to integrate this insurance scheme with primary healthcare in India. [ABSTRACT FROM AUTHOR]

Healthcare consumers may be behaving to some extent based on the nature of healthcare being a necessity or otherwise. The choice of either of public and private providers may depend upon factors like availability, accessibility, cost and quality. To some extent, this is revealed through their elasticities based on income, cost, quality and socio-economic factors. Objective of this paper is to explore the demand for healthcare services in India and estimate consumers' elasticities to these factors. Using logit results we find that an individual may choose his preference for private or public based on distance of facility from residence. It may also depend whether it is rural or urban area and whether the income levels of state are below or above all India average. Comparing our results for two all India surveys, it is observed that people's perception and thus preferences are mostly based on choices of nearby location, suitable timings, presence of medical personnel and less waiting time. The presence of insurance either by a national or state sponsored scheme seems to have changed the nature of healthcare demand in India from a stark necessity to a matter of better choice. [ABSTRACT FROM AUTHOR]

A resilient health system necessitates strong governance, political commitment, effective administrative entities and inter-organisational collaboration. This paper examines India's current health policy landscape and explores the analytical and operational capacities required to establish a robust post-pandemic health system using the policy capacity framework described by Wu et al. (2015). We emphasised the need for a coordinated policy response to strengthen health information systems, health service management, human resource management and healthcare financing. The role that the planned implementation of Indian public health management cadres would play in the coming era, the importance of a comprehensive health information management system and the need for operational coordination between government and non-governmental organisations has also been emphasised. [ABSTRACT FROM AUTHOR]

To analyze randomized trials with imperfect compliance, a standard approach is to estimate the local average treatment effect in the sub-population of compliers using randomization status as an instrumental variable. Though quantile analysis has been popular in general, the local (or complier) quantile treatment effect (cQTE) as a causal estimand has received insufficient attention. In this paper, we map out the details for the estimation, inference, and sensitivity analysis of the cQTE in a completely nonparametric setting. We propose to estimate the cQTE using nonparametric plug-in estimators of the cumulative distribution functions for the potential outcomes of the compliers. The cQTE estimator is shown to be asymptotically normal, with asymptotic variance estimated through kernel-smoothed density estimators. The procedure is easily extended to adjust for discrete covariates for gains in statistical efficiency. Moreover, by exploiting the stochastic monotonicity of the quantile functional, we develop sensitivity bounds for the cQTE when key assumptions such as exclusion restriction and instrument monotonicity are violated. Extensive simulations show that the proposed methods provide valid inference of the target local estimand and outperform standard intent-to-treat tests, especially under low compliance rates and/or heterogeneous treatment effects. A recent study on a government-funded health insurance program in India is analyzed as an illustration. [ABSTRACT FROM AUTHOR]

This study examines the health care utilization pattern, associated financial catastrophes, and inequality across Indian states to understand the subnational variations and aid the policy makers in this regard. Data from recent National Sample Survey (2017–2018), titled, "Household Social Consumption: Health," covering 113,823 households, was employed in the study. Descriptive statistics, Erreygers concentration index (CI), and recentered influence function decomposition were applied in the study. We found that, in India, 7 percent of households experienced catastrophic health expenditure (CHE) and 1.9 percent of households were pushed below poverty line due to out-of-pocket expenditure on hospitalization. Notably, outpatient care was more burdensome (CHE: 12.1%; impoverishment: 4%). Substantial interstate variations were observed, with high financial burden in poorer states. Utilization of health care services from private health care providers was pro-rich (hospitalization CI 0.31; outpatient CI 0.10), while the occurrence of CHE incidence was pro-poor (hospitalization CI −0.10; outpatient CI −0.14). Education level, economic status, health insurance, and area of residence contributed significantly to inequalities in utilization of health care services from private providers and financial burden. The high financial burden of seeking health care necessitates the need to increase public health spending and strengthen public health infrastructure. Also, concerted efforts directed towards increasing awareness about health insurance and introducing comprehensive health insurance products (covering both inpatient and outpatient services) are imperative to augment financial risk protection in India. [ABSTRACT FROM AUTHOR]

Purpose: Social health insurance framework of any country is the national identifier of the country's policy for taking care of its population which cannot access or afford quality healthcare. The purpose of this paper is to highlight the strategic imperatives of digital technology for the inclusive social health models for the BoP customers. Design/methodology/approach: A qualitative exploratory study using in-depth personal interviews with 53 Indian health insurance CXOs was conducted with a semi-structured questionnaire. Using MaxQDA software, the interview transcripts were analyzed by means of thematic content analysis technique and patterns identified based on the expert opinions. Findings: A framework for the strategic imperatives of digital technology in social health insurance emerged from the study highlighting three key themes for technology implementation in the social health insurance sector – analytics for risk management, cost optimization for operations and enhancement of customer experience. The study results provide key insights about how insurers can enhance the coverage of BoP population by leveraging technology. Social implications: The framework would help health insurers and policymakers to select strategic choices related to technology that would enable creation of inclusive health insurance models for BoP customers. Originality/value: The absence of specific studies highlighting the strategic digital imperatives in social health insurance creates a unique value proposition for this framework which can help health insurers in developing a convergence in their risk management and customer delight objectives and assist the government in the formulation of a sustainable social health insurance framework. [ABSTRACT FROM AUTHOR]

The contribution of insurance to rural development in India cannot be underplayed. The insurance sector has made a significant contribution to rural development even though there have been issues related to penetration of insurance in rural areas and absence of covers to meet the specific needs of the villagers. A wide variety of covers are now available for the rural areas. Cattle insurance, crop insurance, tractor insurance, credit risk cover, cover for loss of profit due to untimely rain, drought or bush fire - these are some examples. Rural health insurance is also a priority area that the Government is strongly focusing on as part of Integrated Rural Development Programme (IRDP). This paper traces the contribution of insurance to rural development and chalks out the way forward by which insurance sector can continue to contribute technologyenabled interventions that will support the government's efforts to achieve rural development. [ABSTRACT FROM AUTHOR]

This paper is a comparative study of the level of satisfaction of the health insurance claimants of public and private sector general insurance companies in India. The data is collected from the 100 health insurance policyholders of public and private sector general insurance companies who at one point of time or other has made claim from the insurance company in Greater Mumbai region, Maharashtra, India. Respondents were selected using a simple random method. Primary data was collected with the help of a structured questionnaire. The scope of the study is restricted to the individual and family floater health insurance policy covering sickness and accident. Statistical tools used in the present study are cross tabulation and independent t-test. The findings of the study revealed that majority of the respondents had health insurance claim in the nature of reimbursement from their insurance company. It is also found that majority of the respondents had their health insurance claim processing done through Third Party Administrator (TPA). The overall level of satisfaction with the various claim settlement features of the general insurance companies is relatively higher in the case of the public sector companies as compared to the private sector companies. Further, it can be inferred that statistically there is no significant difference at 5 percent level with respect to their satisfaction from various claim settlement features of the health insurance presented by the company in the public and private sector general insurance companies. The researcher has given suggestions to improve the experience of health insurance claimants from the general insurance companies. [ABSTRACT FROM AUTHOR]

In the absence of a universal health insurance mechanism, the increasing burden of out‐of‐pocket (OOP) health expenditure has become a growing concern in India. To cope with the cost of illness, people use either their savings and income, or they have to rely upon distress means of finance such as depletion of household assets, borrowings from banks and moneylenders, and contributions from family and friends. This paper analyses the changes that have taken place in the incidence and covariates of distress financing in India by using data from National Sample Survey Organisation for the years 2004 and 2014. Results indicate that during this period the incidence of distress sources as a means to finance OOP health expenditure has hovered around 50%. Further, the results reveal a significant socioeconomic gradient in the incidence of distress financing. Socioeconomic and health‐related covariates significantly impact the likelihood of distress financing as a means to cope with OOP health expenditure. The results indicate the need for government action to formulate a comprehensive plan through an increase in public spending on health care that will improve the quantity and quality of the public health‐care system and enhance the scope of health insurance in India. [ABSTRACT FROM AUTHOR]

There are multiple small health insurance schemes throughout India. However, high out-of-pocket (OOP) expenditures, unaffordable and inequitable access to healthcare services still persist. In an attempt to address these pressing issues and achieve universal health coverage (UHC), a national health initiative named Ayushman Bharat (AB) was launched in September 2018, as a part of India's National Health Policy 2017. AB has two main components, first, the health insurance scheme named the National Health Protection Mission (NHPM), which is also branded as 'Pradhan Mantri Jan Arogya Yojana' (PMJAY) and second, transforming the existing primary healthcare centers (PHC) under the control of State Governments. AB aims to transform nearly 150,000 PHCs to deliver comprehensive primary healthcare services across the country by 2022. PMJAY is designed to cover the costs of almost all secondary and many tertiary care procedures of about 40% of the total Indian population. For the first time, attempts have been made to provide affordable healthcare services to the population under a single common initiative in a big, democratic and diverse country like India. This paper provides an overview of the healthcare scheme. We have also analyzed some of its salient features and summarized them for an international audience which is inclusive of academics and public policy researchers. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to evaluate the performance of the Rashtriya Swasthya Bima Yojna (RSBY) in the districts of Uttar Pradesh. The methodology applied includes the Charnes, Cooper and Rhodes (CCR) model of Data Envelopment Analysis (DEA) to find out the relative efficiency of the districts of U.P as well as the Tobit regression model to find the key determinants of the efficiency. The methodology has been applied to the enrolled districts of Uttar Pradesh. The results show that only a few districts are relatively efficient and the policymakers need to work to make the scheme efficient. The findings of this study provide insights into the efficiency of RSBY. This have implications for the efficient management of the scheme. [ABSTRACT FROM AUTHOR]

Background: Health seeking behaviour in the event of illness is influenced by the availability of good health care facilities and health care financing mechanisms. Micro health insurance not only promotes formal health care utilization at private providers but also reduces the cost of care by providing the insurance coverage. Objectives: This paper explores the impact of Sampoorna Suraksha Programme, a micro health insurance scheme on the health seeking behaviour of households during illness in Karnataka, India. Materials and Methods: The study was conducted in three randomly selected districts in Karnataka, India in the first half of the year 2011. The hypothesis was tested using binary logistic regression analysis on the data collected from randomly selected 1146 households consisting of 4961 individuals. Results: Insured individuals were seeking care at private hospitals than public hospitals due to the reduction in financial barrier. Moreover, equity in health seeking behaviour among insured individuals was observed. Conclusion: Our finding does represent a desirable result for health policy makers and micro finance institutions to advocate for the inclusion of health insurance in their portfolio, at least from the HSB perspective. [ABSTRACT FROM AUTHOR]