| Title |
Should Governments engage health insurance intermediaries? A comparison of benefits with and without insurance intermediary in a large tax funded community health insurance scheme in the Indian state of Andhra Pradesh
|
|---|---|
| Published in |
BMC Health Services Research, September 2015
|
| DOI | 10.1186/s12913-015-1028-4 |
| Pubmed ID | |
| Authors |
Srikant Nagulapalli, Sudarsana Rao Rokkam |
| Abstract |
A peculiar phenomenon of engaging insurance intermediaries for government funded health insurance schemes for the poor, not usually found globally, is gaining ground in India. Rajiv Aarogyasri Scheme launched in the Indian state of Andhra Pradesh, is first largest tax funded community health insurance scheme in the country covering more than 20 million poor families. Aarogyasri Health Care Trust (trust), the scheme administrator, transfers funds to hospitals through two routes one, directly and the other through an insurance intermediary. The objective of this paper is to find out if engaging an insurance intermediary has any effect on cost efficiency of the insurance scheme. We used payment data of RAS for the period 2007-12, to find out the influence of insurance intermediary on the two variables, benefit cost ratio defined as benefit payment divided by premium payment, and claim denial ratio defined as benefit payment divided by treatment cost. Relationship between scheme expenditure and number of beds empanelled under the scheme is examined. OLS regression is used to perform all analyses. We found that adding an additional layer of insurance intermediary between the trust and hospitals reduced the benefit cost ratio under the scheme by 12.2 % (p-value = 0.06). Every addition of 100 beds under the scheme increases the scheme payments by US$ 0.75 million (p-value < 0.001). The gap in claim denial ratio between insurance and trust modes narrowed down from 2.84 % in government hospitals to 0.41 % in private hospitals (p-value < 0.001). The scheme is a classic case of Roemer's principle in operation. Introduction of insurance intermediary has the twin effects of reduction in benefit payments to beneficiaries, and chocking fund flow to government hospitals. The idea of engaging insurance intermediary should be abandoned. |
X Demographics
The data shown below were collected from the profile of 1 X user who shared this research output. Click here to find out more about how the information was compiled.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| India | 1 | 100% |
Demographic breakdown
| Type | Count | As % |
|---|---|---|
| Science communicators (journalists, bloggers, editors) | 1 | 100% |
Mendeley readers
The data shown below were compiled from readership statistics for 60 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Unknown | 60 | 100% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Student > Ph. D. Student | 9 | 15% |
| Researcher | 6 | 10% |
| Student > Master | 6 | 10% |
| Student > Postgraduate | 5 | 8% |
| Student > Doctoral Student | 3 | 5% |
| Other | 12 | 20% |
| Unknown | 19 | 32% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 9 | 15% |
| Social Sciences | 8 | 13% |
| Economics, Econometrics and Finance | 6 | 10% |
| Nursing and Health Professions | 5 | 8% |
| Pharmacology, Toxicology and Pharmaceutical Science | 4 | 7% |
| Other | 7 | 12% |
| Unknown | 21 | 35% |
Attention Score in Context
This research output has an Altmetric Attention Score of 13. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 01 November 2022.
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#2,322,005
of 22,788,370 outputs
Outputs from BMC Health Services Research
#936
of 7,626 outputs
Outputs of similar age
#32,964
of 267,155 outputs
Outputs of similar age from BMC Health Services Research
#15
of 143 outputs
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