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

Rinshu Dwivedi (Department of Science and Humanities, Indian Institute of Information Technology, Trichy, India)
Jalandhar Pradhan (Department of Humanities and Social Sciences, National Institute of Technology, Rourkela, India)

International Journal of Human Rights in Healthcare

ISSN: 2056-4902

Article publication date: 9 December 2020

Issue publication date: 4 June 2021

100

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.

Keywords

Acknowledgements

The authors are grateful to the Department of Humanities and Social Sciences, National Institute of Technology, Rourkela for their support and encouragement, and to the esteemed reviewers and editor for their suggestions/comments, which has helped in improving this paper. We received no funding support to undertake this study.

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

Publisher

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Emerald Publishing Limited

Copyright © 2020, Emerald Publishing Limited

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