Public health coverage is not a bulwark against high spending: study | India News

NEW DELHI: The first study in India on state-funded health insurance (PFHI) in the context of “catastrophic health care costs” faced by seniors have found that it is not effective in protecting them financially. About 30% of people with publicly funded health coverage have faced catastrophic expenses while hospitalized in private facilities, and about 7% even of those using public facilities have faced it.
Health expenditures are considered catastrophic when they represent 25% or more of a household’s total annual consumption expenditure.
“Reliance on a poorly regulated private sector appears to be a key limitation of PFHI policy. Governments need to find more effective ways to protect older people from catastrophic health expenditures if the goal of UHC (universal health coverage) must be achieved,” the study said.
The study published in the open-access journal Biomed Central Geriatric last week found that seniors’ enrollment in publicly funded health insurance (PFHI) was not associated with lower out-of-pocket spending ( OOPE) or less “catastrophic health expenditure” (CH-25). According to the study, the use of private facilities was the main determinant of whether older people had to spend huge amounts out of pocket, whether or not they were affiliated with publicly funded health insurance.
The study was conducted by analyzing data from the Longitudinal Aging Study in India (LASI) 2017-2018, a nationwide survey of 72,250 people that collected detailed data on the health of older adults, including disease burden, health care utilization and OOPE. The data showed that 35% of hospitalizations took place in public hospitals and that the average expenditure (OOPE) for hospitalization in public institutions was Rs 8,276 compared to Rs 49,700 in private institutions, which is about six times more.
The analysis only included people who had an episode of hospital care, i.e. 4,616 people, since state-funded health insurance only covers hospitalization expenses. Overall, 18.1% of the elderly were covered by the PFHI. The proportion of people covered by other types of health insurance was relatively low, at 2.6%.

“The average OOPE for private hospital use was lower for those enrolled in PFHI than for non-enrollees. However, the median OOPE for hospitalization in private hospitals was almost equal for those enrolled in PFHI. PFHI and non-registered OOPE median is not affected by extremely high values, but the average is that some people incurred extremely high expenses, which skewed the average,” Samir Garg explained. , one of the authors of the study.
The overall hospitalization rate for seniors was 7.1%. Among those affiliated with public health insurance, the hospitalization rate was 8.8% and it was 6.8% among those not affiliated. “The current study found that enrollment in the PFHI increased the odds of using public facilities for hospitalization. This is surprising, given that one of the goals of the PFHI was to expand the access to hospital care by making the private sector affordable for the poor. This phenomenon may be linked to the failure of the PFHI to really improve the affordability of the private sector,” the study states.
“Private hospitals entered into contracts under PFHI which prohibited them from charging patients anything. However, as the current study shows, they continued to charge patients enrolled under PFHI. Private hospitals in India are poorly Purchasing arrangements through contracts also appear to be ineffective in ensuring price regulation in the Indian private sector The failure of PFHI could be due to a combination of shortcomings – poor government regulation, acceptance culture of illegal payments and the treatment of health care as a market transaction,” the study concluded, recommending further research to understand the “governance gaps” that lead to poor performance of publicly funded health insurance. State in India. Health expenses and about 7% even of those who use public facilities face it.
Health expenditure is considered catastrophic when it represents 25% or more of a household’s total annual consumption expenditure and is abbreviated as CHE25.
“The continued reliance on a poorly regulated private sector appears to be a key limitation of PFHI (publicly funded health insurance) policy. catastrophic health risks if the goal of UHC (universal health coverage) is to be achieved,” the study states.


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