Paper short abstract:

This study examines how health insurance impacts various health outcomes aligned with SDG 3, using NFHS-5 data. It employs descriptive stats and propensity score matching to understand the population's characteristics and estimate the effect of health insurance on health outcomes. Results shed light on this relationship.

Paper long abstract:

Research Context:

In September 2009, member states of the World Health Organization (WHO) in the Asia-Pacific Region adopted a health financing strategy aimed at reducing out-of-pocket payments, increasing total health expenditures, and achieving high coverage with prepayment schemes for over 90% of the population. Then, in 2015, the Sustainable Development Goals (SDGs) highlighted various health objectives in Goal 3. One specific target, 3.8, emphasized the importance of universal health coverage. This target stressed the need for financial protection to improve health outcomes.

India, similar to other Low- and Middle-Income Countries (LMICs), has introduced diverse health insurance schemes to expand financial protection to its citizens. While schemes like the Employee State Insurance and Central Government Health Scheme cater exclusively to government employees, there are broader government initiatives like AB-PMJAY aimed at offering free healthcare services to all and extending health insurance coverage to the economically disadvantaged. In addition to these government-led efforts, there has been a modest rise in private health insurance coverage due to economic growth and increased competition in the healthcare sector. Community-based health insurance schemes, managed and funded at the community level, also play a role by providing coverage to their members.

Despite increasing health insurance coverage in India and considerable governmental efforts, achieving comprehensive coverage and accurately assessing the impact of such schemes remain a significant challenge. Studies attempting to evaluate their effect on health outcomes have produced mixed results, leading to a lack of consensus. Some research has focused on the indirect impact through healthcare service utilization. These studies have revealed variations in the extent of impact across different types of insurance and demographic groups.

In low-income countries like Uganda, community-based health insurance has demonstrated a positive effect on the utilization of preventive health services, such as mosquito net usage and child deworming. Similarly, participation in Social Health Insurance, Community-Based Health Insurance, and National Health Insurance schemes has been linked to increased utilization of mental health care services.

Despite the widespread attention given to health insurance coverage as a means of attaining financial security and improved health outcomes in alignment with SDG 3, there exists a gap in assessing their influence on other health outcomes outlined in the SDGs. While existing research has primarily focused on specific health indicators like maternal health, there is a pressing need for a more expansive evaluation of how health insurance schemes affect various health targets set by the SDGs.

Therefore, this study aims to explore how the type and extent of coverage impact various health outcomes associated with the SDGs. By doing so, it seeks to enhance our understanding of the role of health insurance in advancing overall population health.

Methodology:

Data from the NFHS-5 was used to investigate the effectiveness of health insurance coverage on achieving health outcomes aligned with the SDGs, particularly those under SDG 3, which focuses on health and well-being. The study examines 12 specific health outcomes derived from SDG 3.

Firstly, the study employs descriptive statistics to analyze the characteristics of the sample population and to understand the socioeconomic factors associated with both health insurance coverage and the prevalence of health outcomes. This helps in providing a comprehensive overview of the population being studied and the distribution of health insurance coverage and health outcomes across different socioeconomic groups. In addition to descriptive analysis, the study utilizes propensity score matching (PSM) methodology. PSM allows researchers to compare outcomes between individuals with and without health insurance coverage while controlling for potential confounding variables. This method helps in estimating the causal effect of health insurance coverage on health outcomes, accounting for differences in socioeconomic and demographic characteristics between the two groups.

Analysis & Conclusion:

The findings of the analysis are then presented, highlighting the relationship between health insurance coverage and various health outcomes. Based on these results, the study offers policy recommendations aimed at enhancing the effectiveness of health insurance schemes in improving health outcomes aligned with SDG 3. These recommendations are informed by the observed associations between health insurance coverage, socioeconomic factors, and health outcomes, with the aim of guiding policymakers in designing interventions to maximize the impact of health insurance on public health.

Keywords:

Health Insurance, Coverage Type, Health Outcomes, SDG, India