Principal supervisor for a Masters in Hospital Administration (MHA) Student Disseration. The MHA degree program is offerred by the Apollo Hospital Group, India, and affliated with the Osmania University, Hyderabad. The University is one of the oldest and longest serving Universities in India. 
 
Name of student: Dr Santosh Puri

 

Title of dissertation: Translation of health insurance policy innovation: a study on health micro insurance for below poverty line house holds in Latur district, Maharasthra

 

 

Crisis is common in the lives of poor, and often health related burden/costs can impoverish their households. Health security is increasing being recognised as integral to any poverty reduction strategy. In order to provide security, especially in developing countries like India, health policies should both aim at cost containment and community empowerment. Micro health insurance is considered as a viable alternative, due to the nature of community participation, minimal investment and better risk pooling mechanisms. The present study examines the process of health micro insurance (HMI) innovations for the below poverty line (BPL) people of Latur district. The objectives of the study were to estimate the demand for HMI among BPL people, to determine the burden of health expenses, to describe health care utilisation patterns, to estimate the awareness levels of health insurance, and to formulate policy mechanisms. 

The study was exploratory, covering 14 villages of Jalkot Tehsil; classified as a revelatory case. The sample size was 190 BPL households, selected through systemic random sampling  (every 5th BPL household chosen.) Respondents were above the age of 15 yrs and an oral questionnaire was administered in Marathi. The survey tool consisted of nine sections aimed at various elements such as socio economic factors, demographic profile and health status/related information. Pre coded patterns were employed in the questionnaire and strict ethical standards were followed.

The preliminary findings (major) suggested that around 77% of the surveyed families are interested in participating in a health insurance scheme. 57% of the families preferred an easily accessible community based financial institution for availing insurance. 61% of the families were willing to pay a premium ranging from Rs.120 to Rs.360, and 40% are willing to pay above Rs.360. This was from an average monthly income, which was Rs.2722, and with an 60% of illiterate households It was also established that for inpatient hospitalisation episodes, about 60% paid less than Rs.10,000. 19% of the families reported with some kind of disability. 28% preferred private hospitals and nearly 40% borrowed money while 20% took help from friends/relatives and family.

The findings were analysed though a thematic descriptive analysis to suggest patterns for HMI in Latur. The responses were collated to substantially answer four themes (constructs): demand for HMI, burden of health care expenditures, health care service utilisation patterns, and awareness levels of health insurance. Each theme was categorised into several subthemes, based on the content introduced by the related questions. Later, the subtheme was integrated to the theme by a description on various influencing factors (classified as primary, secondary and tertiary). The study identified eight sub themes and 21 influencing factors for the ‘demand’ construct; five sub themes and 12 influencing factors for the ‘burden’ construct; six themes and 15 influencing factors for the ‘utilisation’ construct; four themes and 11 influencing factors for the ‘awareness’ construct. 

Finally, the study explained the process of translating the HMI insurance innovation through effective policy mechanisms. Seven factors were considered very crucial in developing such an effective policy: affordability, benefits desired, management preferred, willingness to participate, premium financing, subscribing factors and members to be covered. These factors were congregated to develop three modes of polices: ‘umbrella’, ‘combined’ and ‘specific’. This constituted the conceptual model called ‘Translation of Health Insurance Policy Innovation Framework’. Elements of the framework were applied for the development of a plan for successful HMI innovation in Latur, Maharashtra. 

Number of words: 540 
Key words: Health Micro Insurance, Below Poverty Line, Households, Thematic Analysis, Conceptual Framework, Innovation BPL household chosen). Respondents were above the age of 15yrs and an oral
 

A Student Presentation from this project was selected in the National Conference on Globalisation and Health Care organised by the Indian Institute of Health Management Research, Jaipur, India - 8-9th Dec 2007. 

 

More information on this project can be obtained from: drsanthoshpuri@gmail.com(Santosh Puri)