Research on impact of publicly financed health insurance has paid relatively little attention
to the nature of healthcare provision the schemes engage. India's National Health Insurance
Scheme or RSBY was made universal by Chhattisgarh State in 2012. In the State, public
and private sectors provide hospital services in a context of extensive gender, social, economic
and geographical inequities. This study examined enrolment, utilization (public and
private) and out of pocket (OOP) expenditure for the insured and uninsured, in Chhattisgarh.
The Chhattisgarh State Central sample (n = 6026 members) of the 2014 National Sample
Survey (71st Round) on Health was extracted and analyzed. Variables of enrolment, hospitalization,
out of pocket (OOP) expenditure and catastrophic expenditure were descriptively
analyzed. Multivariate analyses of factors associated with enrolment, hospitalization (by
sector) and OOP expenditure were conducted, taking into account gender, socio-economic
status, residence, type of facility and ailment. Insurance coverage was 38.8%. Rates of hospitalization
were 33/1000 population among the insured and 29/1000 among the uninsured.
Of those insured and hospitalized, 67.2% utilized the public sector. Women, rural residents,
Scheduled Tribes and poorer groups were more likely to utilize the public sector for hospitalizations.
Although the insured were less likely to incur out of pocket (OOP) expenditure,
95.1% of insured private sector users and 66.0% of insured public sector users, still incurred
costs. Median OOP payments in the private sector were eight times those in the public sector.
Of households with at least one member hospitalized, 35.5% experienced catastrophic
health expenditures (>10% monthly household consumption expenditure).
The study finds that despite insurance coverage, the majority still incurred OOP expenditure.
The public sector was nevertheless less expensive, and catered to the more vulnerable
groups. It suggests the need to further examine the roles of public and private sectors in
financial risk protection through government health insurance.