Economic and Health Impacts of Hospitalization and Maternity Insurance in India

健康冲击是贫穷家庭面临的最严重的不确定性，这些家庭似乎没有得到充分的保险，这既表现在获得正式保险的机会有限，也表现在非正式保险网络的效力有限。Gruber和Gertler（2002年）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。 家庭在投保严重疾病方面面临特别困难：他们能够投保与严重限制身体功能的疾病相关的收入损失的不到40%。大部分未投保的消费损失是由于收入损失，而不是卫生支出增加，但补偿卫生支出增加的保险计划也可能通过使投保人更快康复来减轻收入损失。Fafchamps和隆德（2003年）研究了菲律宾农村家庭确保消费不受冲击的能力。他们发现，与失业或死亡相比，家庭对健康冲击的保险特别少。 发展中国家妇女面临的主要健康风险和潜在的经济冲击之一是， 分娩时的并发症。许多保健专家认为，适当的产前护理和住院分娩相结合有可能大大降低孕产妇死亡率。然而，在印度，这些预防措施的采用率很低，很大一部分分娩是在家里进行的，或者没有任何帮助，或者只有传统助产士的帮助。2003年，登记长估计，在全国范围内，只有28%的分娩是在机构设施中进行的（印度登记长，2006年）。Duflo和Banerjee于2007年和2008年在乌代浦农村地区完成的一项调查显示，88%的分娩是在家中进行的。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，几乎都没有受过训练的医生在场。在调查前一年出生的婴儿中，这一数字较低（50%），部分原因可能是政府鼓励在医院分娩的计划，下文将详细讨论这一计划。此外，这些妇女中有许多人没有得到产前护理，因此没有得到怀孕期间可能出现并发症的警告：占所有分娩的50%，去年下降到所有分娩的15%。如果出现并发症，妇女需要被送到最近的初级或社区卫生中心，有时可能很远，设备很差，需要贿赂;或者被送到私人设施，通常需要提前付款，因此往往会延迟。在我们的基线调查中，去年13%的分娩有并发症。在三分之二的情况下，妇女必须被送往卫生设施，她们首先必须从某处筹集资金支付护理费用，这进一步拖延了在关键时刻的护理。[This该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，以及如何将其与政府的影响进行比较。 鼓励机构提供服务]。

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.]