Suchergebnisse

Background. One of the constraints in the utilisation of maternal healthcare in India is the out-of-pocket expenditure. To improve the utilisation and to reduce the out-of-pocket expenditure, India launched a cash incentive scheme, Janani Suraksha Yojana (JSY), which provides monetary incentive to the mothers delivering in public facility. However, no study has yet examined the extent to which the JSY payments reduce the maternal healthcare induced catastrophic out-of-pocket expenditure burden of the households. This paper therefore attempts to examine the extent to which the JSY reduces the catastrophic expenditure estimate household expenditure on maternity, i.e., all direct and indirect expenditure. Materials and methods. The study used data on 396 mothers collected through a primary survey conducted in the rural areas of the Varanasi district of Uttar Pradesh state in 2013-2014. The degree and variation in the catastrophic impact of households' maternity spending was computed as share of out-of-pocket payment in total household income in relation to specific thresholds, across socioeconomic categories. Logistic regression was used to understand the determinants of catastrophic expenditure and whether the JSY has any role in influencing the expenditure pattern. Results. Results revealed that the JSY beneficiaries on an average spent about 8.3% of their Annual Household Consumption Expenditure on maternity care. The JSY reimbursement could reduce this share only by 2.1%. The study found that the expenditure on antenatal and postnatal care made up a significant part of the direct medical expenditure on maternity among the JSY beneficiaries. The indirect or non-medical expenditure was about four times higher than the direct expenditure on maternity services. The out-of-pocket expenditure across income quintiles was found to be regressive i.e. the poor paid a greater proportion of their income towards maternity care than the rich. Results also showed that the JSY reimbursement helped only about 8% households to escape from suffering catastrophic burden due to maternity payments. Conclusions. It can be concluded that the JSY appeared to have achieved only a limited success in reducing the economic burden due to maternity. To reduce the catastrophic burden, policy makers should consider increasing the JSY reimbursement to cover not only antenatal and postnatal services but also non-medical expenditure due to maternity. The government should also take appropriate measures to curb non-medical or indirect expenditure in public health facilities.

Introduction: No study has yet attempted to measure mean out-of-pocket expenditure on health care at household level, separately for government and private health facilities in India. Therefore, this study analyses the change in the out-of-pocket expenditure between 1995-96 and 2004 for fifteen major states of India, separately for rural/urban sector and inpatient/outpatient care. Methods: Using data from the 52nd and 60th rounds of the National Sample Survey, we present a disaggregated analysis of the trends and patterns of inflation adjusted household expenditure on health care. Results: The analysis of average household expenditure on health care demonstrated that the mean outpatient care expenditure in government health sector decreased marginally at the aggregate level in both rural and urban sector, whereas it showed a significant increase in private facilities. A substantial rural-urban differential was also observed regarding households" mean hospitalization expenditure in private hospitals while the same was not true for government hospitals. Almost all states observed a very high growth in households" mean hospitalization expenditure in the private sector, while it was quite low in the government sector and even negative in rural areas of some states. The same pattern was observed in the growth pattern of households" outpatient care expenditure. Conclusions: The analyses indicated a little improvement in the performance of government health sector in terms of out-of pocket expenditure. The improvement was more visible in developed and less developed states than in least developed states. Similarly, the improvement was more visible in rural areas than in urban areas.

Introduction: This study aims to understand the dynamics of insurance as a risk management tool for natural disasters in India. It further explores different strategies and programs for disaster insurance adopted by the Indian government and highlights these initiatives' gaps.
Methods: The authors conducted both offline and online desk reviews to understand the dynamics of insurance mechanisms and government strategies. They conducted a narrative review of existing literature, including peer-reviewed articles, thematic books, and government and non-governmental reports from diverse sources.
Results: The review clearly shows that despite the various types of natural disasters the country faces, the coverage of disaster insurance in India remains low. It outlines the importance of insurance as a risk management tool, especially for the most vulnerable sections of society living in rural parts. The review further highlights the benefits of different government schemes and strategies while at the same time highlighting the gaps in these schemes.
Conclusion: The review calls for an urgent and sustained effort to increase the number of individuals insured against natural disasters in the country by addressing the policy shortcomings and engaging with the communities and the private sector to understand their respective needs. The review also underlines the importance of creating awareness regarding disaster insurance among the wider population. Furthermore, it calls for a comprehensive disaster management plan with insurance as one of its pillars.