Determinants of Enrollment in Comprehensive Health Insurance Scheme and Implementation Challenges: A Study in Kerala, South India

Background: Diseases are creating sudden economic shock to households as well as it leads to out of pocket expenditures, undermines income generation and future economic welfare. When people are poor and out of pocket spending is high, it can lead to debt and forced to adopt copying mechanisms. Consequently many poor people do not have the access or go for substandard care. Low public health spending, high out of pocket payments, lack of comprehensive risk pooling mechanism, etc. affect the equity in health financing of India. So, the government, as response to these in efficiencies and a move towards universal health coverage, introduced a community based health insurance scheme in 2008. Introduction of this scheme is designed to improve health care utilization through balancing demand and supply effects of members, healthcare providers and insurance scheme.

Objectives: This study is trying to document 1. The demand side and supply side factors affecting the implementation of Comprehensive Health Insurance scheme (CHIS) in Kerala, 2. To explore the Impact of CHIS on equity concerns and moral hazard.

Methods: The study uses a qualitative case study design. A variety of stakeholders were interviewed using a combination of purposive and snowball sampling to trace out the supply side issues. In depth group interviews conducted to document the demand side factors.

Results: The major demand side factors traced out through in depth group interviews are (1) lack of awareness regarding the benefits of the scheme, (2) outpatient care is excluded, (3) coverage is not enough, (4) provider choice is limited, (5) not happy with the public health facilities etc. The supply side factors are (1) delay in getting funds from government, (2) less incentives, (3) over work load etc. Moral hazards were less compare to other insurance schemes.

Conclusion: Poor people were benefited through the scheme, but delay in settling finds. Gender equity is addressed. Real beneficiaries were not identified and included in the list. So income based equity is questionable.

Author(s):

Devi Nair

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