Economic and Health Impacts of Hospitalization and Maternity Insurance in India

印度住院和生育保险对经济和健康的影响

• 批准号: 8015439
• 负责人: ESTHER DUFLO
• 金额: $ 20.16万
• 依托单位: MASSACHUSETTS INSTITUTE OF TECHNOLOGY
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-25 至 2015-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8015439
• 关键词: Baseline Surveys; Behavior; Birth; Bundling; Caring; Catastrophic Health Insurance; Cessation of life; Charge; Childbirth; Client; Community Health Centers; Complication; Consumption; Control Groups; Country; Data Set; Developing Countries; Drops; Economics; Effectiveness; Employee Strikes; Event; Face; Family; Female of child bearing age; Government; Government Programs; Health; Health Care Seeking Behavior; Health Expenditures; Health Insurance; Health Status; Health care facility; Home environment; Hospital Costs; Hospitalization; Hospitals; Hour; Household; Incentives; Income; India; Individual; Indonesia; Infant Mortality; Institution; Insurance; Insurance Coverage; Lead; Marketing; Maternal Mortality; Maternal and Child Health; Measures; Occupations; Outcome; Personal Satisfaction; Physical Function; Physicians; Policies; Pregnancy; Pregnant Women; Probability; Public Facilities; Public Health; Randomized; Rest; Risk; Rural; Sales; Sampling; Scheme; Shock; Specialist; Surveys; The Sun; Time; Traditional Birth Attendants; Training; Uncertainty; Uninsured; Voluntary Health Insurance; Woman; adverse outcome; coping; design; experience; financial incentive; health economics; payment; programs; response; willingness

Health shocks are among the most serious forms of uncertainty faced by poor families, and these families appear to be poorly insured against them, both in terms of limited access to formal insurance and the limited effectiveness of their informal insurance networks. Gruber and Gertler (2002) show that, in Indonesia, household non-health consumption decreases substantially when households experience health shocks. Households face particular difficulty in insuring severe illnesses: they are able to insure less than 40 percent of the income loss associated with illnesses that severely limit physical function. Much of the uninsured loss of consumption is due to lost income rather than higher health expenditure, but an insurance scheme that compensates for increased health expenditures might also mitigate income losses by enabling subscribers to get well faster. Fafchamps and Lund (2003) examine the ability of rural Philippine households to insure consumption against shocks. They find that households are particularly poorty insured against health shocks, compared to job losses or deaths. One of the key health risks and potential financial shocks faced by women in developing countries is complications during childbirth. A comtiination of proper antenatal care and institutional delivery is considered by many health specialists as having the potential to greatly reduce maternal mortality. Yet take-up in India of these preventative measures is low with a large fraction of births taking place at home, either without any assistance or with only the assistance of a traditional birth attendant. Nationwide, in 2003, the registrar general estimated that only 28 percent of births took place in an institutional facility (Registrar General, India, 2006). In a survey Duflo and Banerjee completed in rural Udaipur district in 2007 and 2008, 88 percent of births took place at home. In the baseline survey for the present study, in Karnataka, 85 percent of all births to women in the sample took place at home, nearly all without a trained physician in attendance. This number is lower (50 percent) for the births that occurred in the year prior to the survey, perhaps in part because of a government scheme to encourage institutional delivery discussed in more detail below. Moreover, many of these women received no antenatal care, and therefore had not been warned of possible complications during the pregnancies: 50 percent of all births, down to 15 percent of all births in the last year. If a complication does arise, the woman needs to either be transported to the nearest Primary or Community Health Center, which can sometimes be far away, poorly equipped, and require bribes; or be transported to a private facility, which generally requires payment in advance, and therefore tends to happen with delay. In our baseline survey, 13 percent of the births that took place in the last year had complications. In two-thirds of the cases where the women had to be transported to a health facility, they first had to collect money from somewhere to pay for the care, further delaying care at that crucial time. [This project will study how market players (private insurance) can be used to encourage the use of hospital delivery, and how this compares to the Impact of a government's incentive for institutional delivery.]

健康冲击是贫困家庭面临的最严重的不确定性形式之一，这些家庭似乎没有为健康冲击投保，无论是获得正规保险的机会有限，还是其非正式保险网络的效力都有限。Gruber和Gertler(2002)表明，在印度尼西亚，当家庭经历健康冲击时，家庭非健康消费大幅减少。 家庭在为严重疾病投保方面面临着特别困难：他们能够为与严重限制身体功能的疾病相关的收入损失提供不到40%的保险。未参保的消费损失很大程度上是由于收入损失，而不是医疗支出增加，但补偿医疗支出增加的保险计划也可能通过使订户更快康复来缓解收入损失。FafChamps和Lund(2003)研究了菲律宾农村家庭确保消费免受冲击的能力。他们发现，与失业或死亡相比，家庭在健康冲击方面的保险尤为匮乏。 发展中国家妇女面临的主要健康风险和潜在的金融冲击之一是 分娩过程中的并发症。许多卫生专家认为，适当的产前护理和机构分娩相结合，有可能极大地降低产妇死亡率。然而，在印度，这些预防措施的接受率很低，很大一部分分娩是在家里进行的，要么没有任何帮助，要么只有传统的助产士帮助。2003年，在全国范围内，登记总长估计，只有28%的出生是在机构机构中出生的(印度登记总长，2006年)。在2007年和2008年在乌代布尔农村地区完成的Duflo和Banerjee的一项调查中，88%的婴儿是在家里出生的。在本研究的基线调查中，在卡纳塔克邦，样本中85%的妇女在家中分娩，几乎所有的分娩都没有训练有素的医生在场。这一数字在调查前一年出生的婴儿中较低(50%)，可能部分原因是政府鼓励机构分娩的计划，下文将更详细地讨论。此外，这些妇女中的许多人没有接受产前护理，因此没有得到怀孕期间可能出现的并发症的警告：占所有新生儿的50%，去年下降到所有新生儿的15%。如果确实出现并发症，妇女需要要么被送到最近的初级或社区卫生中心，有时可能很远，设备简陋，需要贿赂；要么被送到私人机构，这通常需要预付款，因此往往会延迟发生。在我们的基线调查中，去年发生的分娩中有13%出现了并发症。在三分之二的妇女必须被送往医疗机构的情况下，她们首先必须从某个地方筹集资金来支付医疗费用，在那个关键时刻进一步拖延了医疗。[这个项目将研究如何利用市场参与者(私人保险)来鼓励使用医院分娩，以及这与政府的影响相比如何 对机构交付的激励。]