Original Research Article
Year: 2018 | Month: September | Volume: 8 | Issue: 9 | Pages: 207-214
Out of Pocket Health Expenditure and Catastrophic Health Expenditure among the Beneficiaries of Comprehensive Health Insurance Scheme in Kerala
Nikhila Narayanan, Prakash Babu Kodali
Department of Public Health and Community Medicine, Central University of Kerala, Kasaragod, Kerala, India. 671316
Corresponding Author: Nikhila Narayanan
ABSTRACT
Background: Health insurance is considered as one of the mechanisms to ensure access to health care and a means of achieving universal health coverage. Within Indian context several government funded health insurance schemes were initiated. The current study assessed the out of pocket health expenditure (OOPE) and catastrophic health expenditure (CHE) among the beneficiaries of Comprehensive Health Insurance Scheme in Kerala.
Methodology: A cross sectional survey was done among 141 beneficiaries in Kasaragod district of Kerala. Households were interviewed with the post hospitalization interview schedule for the RSBY scheme with making necessary changes. OOPE and CHE were estimated using respective formulas. Bivariate analysis were used to identify the factors associated with OOPE and CHE. Simple linear regression and binary logistic regression was used to identify the impact of factors influencing OOPE and CHE respectively.
Results: The study results showed that 100% of the beneficiaries incurred OOPE and 76.6% of the beneficiaries incurred catastrophic health expenditure. Factors associated with CHE were transportation charges(OR=5.20,95% CI 2.07-13.02), distance from the hospital (OR=4.82,95%CI=1.73-13.44), bystander expenditure(OR = 4.67,95% CI 1.78-12.21) and days of admission(OR = 2.79,95% CI = 1.15-6.74). Factors associated with OOPE includes Type of disease (OR = 3.70, 95% CI 1.66- 8.23), distance from the hospital(r =0.34, p =<0.01), Transport charges (r = 0.30, p =<0.01), Bystander expenditure(r =0.20, p= <0.01) and Insured amount(r = 0.32, p= < 0.01).
Conclusion: Though the scheme helped to improve the health care utilization, it provided limited protection against high health care costs and indirect expenditure. Public health system strengthening along with policy modifications within CHIS will help to improve it further.
Key words: Health Insurance, Universal Health Coverage, RSBY, CHIS, OOPE, CHE