Barriers to the accessibility of health insurance in elderly patients attending NCD clinic in a tertiary care hospital Trichy, Tamil Nadu: a mixed-method study

Authors

  • Deodatt M. Suryawanshi Department of Community Medicine, Government Medical College, Alibag, Maharashtra, India https://orcid.org/0000-0001-5569-8889
  • Divya Rajasehran Department of Community Medicine, Trichy SRM Medical College Hospital and Research Centre, Trichy, Tamil Nadu, India
  • Kalaipriya Gunasekaran Department of Community Medicine, Trichy SRM Medical College Hospital and Research Centre, Trichy, Tamil Nadu, India
  • Suguna Anzbhagan Department of Community Medicine, Trichy SRM Medical College Hospital and Research Centre, Trichy, Tamil Nadu, India
  • Sandeep Mali Department of Community Medicine, Government Medical College, Alibag, Maharashtra, India

DOI:

https://doi.org/10.18203/2394-6040.ijcmph20240628

Keywords:

Geriatric, Catastrophic, Elderly, Health expenditure, Health insurance

Abstract

Background: Health insurance schemes launched by governments have been inadequate to provide health coverage to the vulnerable elderly population. This research aimed to study the prevalence, preference, and pattern of health insurance coverage among the study participants and barriers to its accessibility.

Methods: It was a facility-based Sequential explanatory mixed-method study where patients above 60yrs attending the non-communicable disease OPD were recruited by systematic random sampling and enquired using a semi-structured questionnaire for the prevalence, preference, and pattern of health insurance. Focussed Group discussions (FGD) were later conducted to explore the barriers faced by participants in accessing health insurance.

Results: Health Insurance coverage among the study participants was 74.5%. Of the participants who had any type of health insurance, 86.7% had public health insurance. About three fourth (73.8%) of those who had health insurance were covered under the CMCHIS. Mean health insurance coverage provided was significantly higher by private health insurance (INR170897.4) as compared to both the LIC and CMCHIS (p<0.01) while premium charged was significantly higher for LIC (INR 10003.3/yr.) as compared to others (p<0.01). Institutional issues, lack of awareness, and economic dependence on children were considered as barriers to the accessibility of health insurance among elderly.

Conclusions: A dedicated universal Health Insurance Programme with higher monetary coverage and low premium involving all elderly populations may provide necessary financial risk protection and reduce out-of-pocket health expenditure.

References

Universal Health Coverage. World Bank. Available at: https://www.worldbank.org/en/topic/universal healthcoverage#1. Accessed 8 December 2021.

Ministry of Health and Family Welfare. National Health policy. Delhi: Government of India, 2017. Available at: https://www.nhp.gov.in/nhpfiles/ national_health_policy_2017.pdf. Accessed 8 December 2021.

National Health Authority. About Pradhan Mantri Jan Arogya Yojana (PM-JAY). Available at: https://pmjay.gov.in/about/pmjay. Accessed 8 December 2021.

Mahatma Jyotirao Phule Jan Arogya Yojana. Available at: https://www.jeevandayee. gov.in/MJPJAY/. Accessed 8 December 2021.

Chief Ministers Comprehensive Health Insurance Scheme. Available at: https://www.cmchistn.com/ features.php. Accessed 8 December 2021.

Ministry of Health and Family welfare, Government of India. National Health Account Technical Secretariat, National Health Resource Centre, 2021. National Health Accounts Estimates for India 2017-18. Available at: https://nhsrcindia.org/sites/ default/files/2021-11/National%20Health%20 Accounts-%202017-18.pdf. Accessed 8 December 2021.

Healthcare Financing Division, National Health Systems Resource Center, Ministry of Health and Family Welfare, Government of India. Household Healthcare Utilization & Expenditure in India : State Fact Sheets. 2014;1–62. Available at: http://nhsrcindia.org/sites/default/files/State Fact Sheets_Health care Utilization and Expenditure in India.pdf. Accessed 8 December 2021.

NSSO. Health in India: NSS 75th Round, 2020. Available at: http://mospi.nic.in/sites/default/files/ publication_reports/NSS Report no. 586 Health in India.pdf. Accessed 8 December 2021.

National Statistical Office. Elderly in India 2021. 2021. Available at: http://mospi.nic.in/sites/default/ files/publication_reports/ElderlyinIndia2021.pdf. Accessed 8 December 2021.

United Nations, Department of Economic and Social Affairs, Population Division (2015). World Population Ageing, 2015. Available at: https://www.un.org/development/desa/pd/content/world-population-ageing-2015. Accessed 8 December 2021.

Whitehouse E. Social Protection for Older Persons: Key Policy Trends and Statistics. Social Protection Department, ILO. 2014.

Ministry of Health and Family Welfare. National Family Health Survey – 4 (NFHS‑4) ‑ India Fact Sheet. Mumbai: International Institute for Population Sciences, 2015‑16. Available at: http://rchiips.org/nfhs/pdf/NFHS4/India.pdf. Accessed 22 October 2021.

Ministry of Health and Family Welfare. National Family Health Survey – 4 (NFHS‑4) ‑ Tamil Nadu Fact Sheet. Mumbai: International Institute for Population Sciences, 2015‑16. Available at: http:// rchiips.org/nfhs/pdf/NFHS4/TN_FactSheet.pdf. Accessed 22 October 2021.

Madhukumar S, Sudeepa D, Gaikwad V. Awareness and perception regarding health insurance in Bangalore rural population. Int J Medi Pub Hea. 2012;2(2).

Chulis GS, Eppig FJ, Hogan MO, Waldo DR, Arnett III RH. Health insurance and the elderly: data from MCBS. Health Care Finan Rev. 1993;14(3):163.

Allcock SH, Young EH, Sandhu MS. Sociodemographic patterns of health insurance coverage in Namibia. Int J Equ Heal. 2019;18(1):1-1.

Wang Z, Li X, Chen M, Si L. Social health insurance, healthcare utilization, and costs in middle-aged and elderly community-dwelling adults in China. Int J Equ Heal. 2018;17(1):1-3.

Ponnusamy P, Venugopal V, Dongre AR. Health insurance coverage and its determinants among middle-income households in Urban Puducherry: A mixed methods study. Ind J Publ Heal. 2021;65(3):231-6.

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Published

2024-02-29

How to Cite

Suryawanshi, D. M., Rajasehran, D., Gunasekaran, K., Anzbhagan, S., & Mali, S. (2024). Barriers to the accessibility of health insurance in elderly patients attending NCD clinic in a tertiary care hospital Trichy, Tamil Nadu: a mixed-method study. International Journal Of Community Medicine And Public Health, 11(3), 1252–1258. https://doi.org/10.18203/2394-6040.ijcmph20240628

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Original Research Articles