Indian community health insurance schemes provide partial protection against catastrophic health expenditure
Indian community health insurance schemes provide partial protection against catastrophic health expenditure
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DOI：
10.1186/1472-6963-7-43
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发表时间：
2007-03-15
影响因子：
2.8
通讯作者：
Van der Stuyft, Patrick
中科院分区：
文献类型：
--
作者：
Devadasan, Narayanan;Criel, Bart;Van der Stuyft, Patrick
在印度，超过72%的卫生支出是由个人家庭在患病时通过自付支付的方式支付的。这是一种高度倒退的保健筹资方式，有时会导致贫困。建议将健康保险作为保护家庭免受此类灾难性医疗支出（CHE）影响的措施。我们研究了两个印度社区健康保险（CHI）计划，ACCORD和SEWA，以确定投保家庭是否受到保护CHE.Methods：ACCORD提供健康保险覆盖的土著人口，生活在古达卢尔，泰米尔纳德邦。自营职业妇女协会为古吉拉特邦的自营职业妇女提供保险。这两项计划均涵盖住院费用，但最高限额分别为23美元和45美元，我们审查了这两项计划的保险索赔登记册，并确定了2003年4月1日至2004年3月31日期间住院的患者。获得了他们的诊断、治疗地点和费用以及自我报告的年收入的详细信息。CHE没有单一的定义，这些定义都没有得到验证。在这项研究中，我们使用了以下定义;“年医院支出大于10%的年收入，”以确定那些经历CHE.Results：共有683和3152住院ACCORD和SEWA，分别。在没有CHI计划的情况下，ACCORD和SEWA的所有患者都必须支付OOP的住院费用。在CHI计划下，分别有67%和34%的患者无需自付任何ACCORD和SEWA的住院费用。这两个CHI计划通过支付医院费用将经历CHE的家庭数量减半。然而，尽管如此，4%和23%的入院家庭仍然分别在ACCORD和SEWA经历了CHE。这是有关以下条件：低年收入，低最高限额的福利包，排除某些条件的福利包，并使用私营部门的admission.Conclusion：CHI似乎是有效的住院患者中CHE的发病率减半。通过改善CHI计划的设计，特别是通过提高福利计划的上限，尽量减少排斥和控制成本，可以进一步加强这种保护。
Background: More than 72% of health expenditure in India is financed by individual households at the time of illness through out-of-pocket payments. This is a highly regressive way of financing health care and sometimes leads to impoverishment. Health insurance is recommended as a measure to protect households from such catastrophic health expenditure (CHE). We studied two Indian community health insurance (CHI) schemes, ACCORD and SEWA, to determine whether insured households are protected from CHE.Methods: ACCORD provides health insurance cover for the indigenous population, living in Gudalur, Tamil Nadu. SEWA provides insurance cover for self employed women in the state of Gujarat. Both cover hospitalisation expenses, but only upto a maximum limit of US$ 23 and US$ 45, respectively.We reviewed the insurance claims registers in both schemes and identified patients who were hospitalised during the period 01/04/2003 to 31/03/2004. Details of their diagnoses, places and costs of treatment and self-reported annual incomes were obtained. There is no single definition of CHE and none of these have been validated. For this research, we used the following definition; "annual hospital expenditure greater than 10% of annual income," to identify those who experienced CHE.Results: There were a total of 683 and 3152 hospital admissions at ACCORD and SEWA, respectively. In the absence of the CHI scheme, all of the patients at ACCORD and SEWA would have had to pay OOP for their hospitalisation. With the CHI scheme, 67% and 34% of patients did not have to make any out-of-pocket (OOP) payment for their hospital expenses at ACCORD and SEWA, respectively. Both CHI schemes halved the number of households that would have experienced CHE by covering hospital costs. However, despite this, 4% and 23% of households with admissions still experienced CHE at ACCORD and SEWA, respectively. This was related to the following conditions: low annual income, benefit packages with low maximum limits, exclusion of some conditions from the benefit package, and use of the private sector for admissions.Conclusion: CHI appears to be effective at halving the incidence of CHE among hospitalised patients. This protection could be further enhanced by improving the design of the CHI schemes, especially by increasing the upper limits of benefit packages, minimising exclusions and controlling costs.