BACKGROUND:A national Publicly Funded Health Insurance (PFHI) scheme called Pradhan Mantri Jan Arogaya Yojana (PMJAY) was launched by government of India in 2018. PMJAY seeks to cover 500 million persons with an annual cover of around 7000 USD per household. PMJAY claims to be the largest government funded health scheme globally and has attracted an international debate as a policy for Universal Health Coverage. India's decade-long experience of the earlier national and state-specific PFHI schemes had shown poor effectiveness in financial protection. Most states in India have completed a year of implementation of PMJAY but no evaluations are available of this important scheme. METHODS:The study was designed to find out the effect of enrolment under PMJAY in improving utilisation of hospital services and financial protection in Chhattisgarh which has been a leading state in implementing PFHI in terms of enrolment and claims. The study analyses three repeated cross-sections. Two of the cross-sections are from National Sample Survey (NSS) health rounds - year 2004 when there was no PFHI and 2014 when the older PFHI scheme was in operation. Primary data was collected in 2019-end to cover the first year of PMJAY implementation and it formed the third cross-section. Multivariate analysis was carried out. In addition, Propensity Score Matching and Instrumental Variable method were applied to address the selection problem in insurance. RESULTS:Enrollment under PMJAY or other PFHI schemes did not increase utilisation of hospital-care in Chhattisgarh. Out of Pocket Expenditure (OOPE) and incidence of Catastrophic Health Expenditure did not decrease with enrollment under PMJAY or other PFHI schemes. The size of OOPE was significantly greater for utilisation in private sector, irrespective of enrollment under PMJAY. CONCLUSION:PMJAY provided substantially larger vertical cover than earlier PFHI schemes in India but it has not been able to improve access or financial protection so far in the state. Though PMJAY is a relatively new scheme, the persistent failure of PFHI schemes over a decade raises doubts about suitability of publicly funded purchasing from private providers in the Indian context. Further research is recommended on such policies in LMIC contexts.

译文

背景:印度政府于2018年启动了一项名为Pradhan Mantri Jan Arogaya Yojana(PMJAY)的国家公共医疗保险计划。PMJAY旨在覆盖5亿人,每户每年约7000美元。 PMJAY声称是全球最大的政府资助的医疗计划,并作为全民医疗保险的政策引起了国际关注。印度在较早的针对特定国家和州的PFHI计划的十年经验表明,在金融保护方面效果不佳。印度大多数州已经完成了PMJAY的实施一年,但没有对该重要计划进行评估。
方法:本研究旨在查明在贾蒂斯加尔邦PMJAY项下登记对改善医院服务的利用和财务保护的影响,该市在实施PFHI方面在登记和索赔方面一直处于领先地位。该研究分析了三个重复的横截面。其中两个横截面来自国家抽样调查(NSS)健康调查-2004年没有PFHI,而2014年则是较旧的PFHI计划正在实施。在2019年底收集了主要数据,以涵盖实施PMJAY的第一年,并形成了第三部分。进行多变量分析。此外,运用倾向得分匹配和工具变量法解决了保险业的选择问题。
结果:在恰蒂斯加尔邦,根据PMJAY或其他PFHI计划进行的入学并未增加医院护理的利用率。在PMJAY或其他PFHI计划下,自费支出(OOPE)和灾难性健康支出的发生率并未随入学率而降低。不论PMJAY是否注册,OOPE的规模都显着更大,可用于私营部门。
结论:PMJAY提供的纵向覆盖比印度早期的PFHI方案大得多,但到目前为止,该州仍无法改善访问权限或财务保护。尽管PMJAY计划是一个相对较新的计划,但PFHI计划在过去十年中持续失败,这引发了人们对在印度背景下从私人提供商处购买公共资助的采购是否合适的怀疑。建议在LMIC背景下对此类政策进行进一步研究。

+1
+2
100研值 100研值 ¥99课程
检索文献一次
下载文献一次

去下载>

成功解锁2个技能,为你点赞

《SCI写作十大必备语法》
解决你的SCI语法难题!

技能熟练度+1

视频课《玩转文献检索》
让你成为检索达人!

恭喜完成新手挑战

手机微信扫一扫,添加好友领取

免费领《Endnote文献管理工具+教程》

微信扫码, 免费领取

手机登录

获取验证码
登录