Revisiting equity in healthcare spending through capability-approach: assessing the effectiveness of health-insurance schemes in reducing OOPE and CHE in India

Abstract

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.

Citation

Dwivedi, R. and Pradhan, J. (2021), "Revisiting equity in healthcare spending through capability-approach: assessing the effectiveness of health-insurance schemes in reducing OOPE and CHE in India", International Journal of Human Rights in Healthcare, Vol. 14 No. 2, pp. 117-132. https://doi.org/10.1108/IJHRH-08-2020-0070