Knowledge and perceptions about health insurance among providers and patients and the intensity of catastrophic health expenditure in Mumbai

Abstract

India is one of the laggards in the Human Development Index. The main reason is that the expenditure on health by the Government as a percentage of GDP is the lowest in the world. Studies show that the health infrastructure is quite inadequate to provide even the basic services to the population. It also reflects that about 80% of outpatients and 40-60% inpatients use private health care facilities in India. It is also estimated that at least 24% of Indians hospitalized fall below the poverty line. Despite rapid Technological and Scientific advancement in the health sector, it is not reaching to poor. It is due to increasing cost of Health Care which is unaffordable to the poor. Rising cost of treatment, diagnosis and drug, further makes deplorable situation for them. Various studies have shown that there is a direct relation between poor health and poverty. Scarce resources available with developing countries are forcing them to reduce allocation towards the health. In such a situation, Health Insurance seems to bean innovative solution to protect the poor from falling in a debt trap. It also helps in reducing the catastrophic health expenditure among the poor. Not many studies have been done on the catastrophic health expenditure in India. Even most of them are based on the studies conducted in the rural area. Therefore, this study tries to understand the catastrophic health expenditure level in the urban setting, i.e. Mumbai. This study also tries to know that how many of the urban patients and service providers know about health insurance. In Mumbai, 1178 are registered. Hospitals have been were stratified in three categories. 341 patients have been selected from different strata of the hospitals. This study finds that even in the financial capital of India i.e. Mumbai, the knowledge and perception about health insurance is not satisfactory. Only 57.77% of the selected patients knew about any kind of health insurance scheme being run by government, private sector or other community. The study found that only 18.18% of the patients are having the health insurance. About 21.7% of patients are facing the catastrophe health expenditure. Studies have shown that despite spending one of the highest per capita expenditure on health in the world, USA has the lowest life expectancy and the highest IMR among developed nations. This is because; in percentage terms, the state(s) spends one of the lowest as compared to other developed countries. Therefore, besides encouraging the private and community based health insurance in India, the Indian government should also encourage government sponsored universal health care delivery to minimize the impact of catastrophic health expenditure among poor. It is also true with the urban areas.