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Introduction: Since the Government of India has decided to continue with the publicly funded health insurance (PFHI) strategy, it is now pertinent to attempt to determine the factors that drive health insurance coverage in India. The NITI (National Institute for Transforming India) Aayog (i.e. Commission) is the apex public policy think tank of the Government of India. The NITI Aayog assesses the health status of the states through its acclaimed health index consisting of 24 indicators for health outcomes, governance and infrastructure. All states and Union Territories (UTs) are ranked on the index. This study aims to assess associations between NITI Aayog health index scores and health insurance coverage across India through a state-level lens. Methods: Health insurance coverage data has been extracted from the National Family Health Survey (NFHS) 4 and NFHS-5 data. NFHS-4 was conducted during 2015–16. NFHS-5 was interrupted by the COVID-19 pandemic and conducted in two phases from 2019 to 2021. This change in health insurance coverage is mapped to the NITI Aayog health index scores for the states and UTs. The NITI Aayog has classified states into two categories: Larger states and smaller states. Based on performance in health indices, NITI Aayog also classifies the states and UTs as Aspirants, Achievers and Front runners. Results and discussion: There is a positive linear relationship between the health index scores of front-runners (Pearson's r = 0.6037, p = 0.029) and the total insurance coverage. We observe poor linear relationship between the health index scores of achievers (Pearson's r = 0.2822, p = 0.498) and the total insurance coverage. There is no linear relationship between the NFHS-5 Total Insurance Coverage and the NITI Health Index Scores (Pearson's r = 0.2766, p = 0.125). Also, we observe a moderate positive linear relationship between the health index scores and the total insurance coverage among the Union Territories which is not statistically significant (Pearson's r = 0.4343, p = 0.465). A similar conclusion is made in the context of smaller states (Pearson's r = 0.3692, p = 0.368) and larger states (Pearson's r = 0.2103, p = 0.387). At the same time, we observe a decrease in insurance coverage across NFHS-4 and NFHS-5 in some states and UTs. Further research is needed to identify the determinants of these spatial changes across a span of five years, from a temporal lens.

Background: In India, policymakers are in an opined that expansion of public-funded health insurance is the key to achieve Universal Health Coverage (UHC). Despite untapped potential to be part of such government-run public-funded health scheme, many private service providers are reluctant to join in such scheme due to various reasons. This paper aims to evaluate facilitators, barriers and perception to participation of the private sector health facilities in Health Insurance & government-led schemes. Methods: Present study was conducted in 83 private hospitals of Vadodara city. Sampling frame was formed & with the use of random number table, 83 hospitals were selected randomly. Data collection was done in pre tested, pre formed questionnaire & respondents were the medical superintendent or the person in-charge of the hospital. Results: In the present study 30% & 26% of hospitals were enrolled for cashless private health insurance facility & government health schemes respectively. Social service, competition and increase clientele were the common reason sought for enrolment in government health schemes. Low & delayed reimbursement, bribe to clear payment, limited services covered, administrative issues were the common problems identified for non-enrolment. There was an association between a number of beds in the hospital & enrolment to government health scheme (p

Objective: To review the importance of evidence-based methods in health insurance reimbursement for achieving universal health coverage in India., Methods: A narrative literature review was performed., Results: The out-of-pocket (OOP) healthcare expenditure in India is among the highest in the world. This situation is despite the implementation of numerous government health schemes and the availability of a large number of health insurance programs, both public and private. Compromised quality of care in many public healthcare facilities is a major factor driving the average Indian citizen to increasingly depend upon private healthcare facilities, further escalating OOP spending. The low awareness and poor uptake of insurance policies among Indians is one of the biggest challenges in the implementation of universal health coverage (UHC) in India. The catastrophic burden of high OOP expenses on individual households could be reduced by taking steps to enhance health insurance uptake, which can be in turn achieved by strengthening the healthcare reimbursement system in India., Conclusions: The application of the principles of evidence-based healthcare for reimbursement requires the systematic assessment of all health technologies, which is already being done in developed countries. The enactment of health schemes such as Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana and setting up of Health Technology Assessment in India are steps toward reducing OOP expenditure and achieving UHC in India. We review the importance and challenges of evidence-based reimbursement and health technology assessment toward achieving UHC in India., (Copyright © 2020. Published by Elsevier Inc.)