Department of Medicine and Community and Family Medicine, All India Institute of Medical Sciences, Saket Nagar, Bhopal 462024, Madhya Pradesh, India.
Department of Medicine, Mahatma Gandhi Institute of Medical Sciences, Wardha, Maharashtra, India.
Natl Med J India. 2020 Mar-Apr;33(2):74-82. doi: 10.4103/0970-258X.310921.
. Community-based health insurance (CBHI) is a health-financing mechanism based on voluntary membership, risk pooling, with a non-profit objective and relies on social capital as a driving force. It aims to improve equity in healthcare utilization in the community. We did this study to understand if CBHI schemes reach the poor, improve healthcare utilization and protect them from catastrophic health events.
. Mahatma Gandhi Institute of Medical Sciences (MGIMS), Sevagram, located in Wardha district of Maharashtra, India, runs a variety of CBHI schemes in surrounding villages. Many households (HHs) have opted for these schemes. We conducted a cross-sectional survey of all HHs of 35 villages and collected information about sociodemographics, inpatient healthcare utilization (in previous 5 years), outpatient healthcare utilization (in previous 1 year) and insurance status of the HHs. We derived wealth index based on 33 sociodemographic variables and classified HHs in quintiles of wealth index. We compared the distribution of healthcare utilization variables by insurance status and wealth index and used logistic regression to evaluate if health insurance independently improves healthcare utilization, after adjusting for confounders.
. Of a total of 7261 HHs surveyed, 2210 (30.4%) were uninsured, 4153 (57.2%) were insured under MGIMS CBHI schemes, and 898 (12.4%) had family insurance either from MGIMS or other providers. Insured HHs had a higher wealth index compared to uninsured. Mean (SD) hospitalization episodes in an HH were 0.82 (1.75) among uninsured, 1.13 (1.56) in CBHI insured and 1.21 (1.55) in those with family insurance. Within each category, healthcare utilization was lower for poor HHs (lowest quintile of wealth index) and higher for affluent HHs (higher quintiles of wealth index). Among those who were hospitalized, catastrophic health events were less in CBHI insured (7.9%) compared to uninsured (12.3%). After adjusting for socioeconomic status and other confounders, our data suggest that participating in a CBHI scheme increased odds of utilization of inpatient services (OR 1.18; 95% CI 1.04-1.33) and protected from catastrophic health events (OR 0.52; 95% CI 0.43-0.64).
. CBHI schemes improve healthcare utilization and protect against catastrophic health expenditure among those who get hospitalized. However, there also exists a socioeconomic gradient both in membership and in utilization of healthcare services favouring those who are more affluent.
社区健康保险（CBHI）是一种基于自愿参保、风险共担、非营利性目标并依赖社会资本作为驱动力的医疗保险机制。它旨在提高社区内医疗服务利用的公平性。我们进行这项研究是为了了解 CBHI 计划是否覆盖了贫困人口，是否提高了医疗服务的利用程度，并保护他们免受灾难性的健康事件的影响。
位于马哈拉施特拉邦沃德哈区的马哈特玛·甘地医学科学研究所（MGIMS）在周边村庄运营着各种 CBHI 计划。许多家庭（HH）选择了这些计划。我们对 35 个村庄的所有 HH 进行了横断面调查，收集了社会人口统计学、住院医疗服务利用（前 5 年）、门诊医疗服务利用（前 1 年）和 HH 保险状况等信息。我们根据 33 个社会人口统计学变量得出了财富指数，并将 HH 分为五个财富指数五分位数。我们比较了保险状况和财富指数对医疗服务利用变量的分布，并使用逻辑回归来评估在调整了混杂因素后，医疗保险是否能独立提高医疗服务的利用程度。
在接受调查的 7261 个 HH 中，2210 个（30.4%）没有保险，4153 个（57.2%）参加了 MGIMS CBHI 计划，898 个（12.4%）有家庭保险，来自 MGIMS 或其他提供者。参保的 HH 的财富指数高于未参保的 HH。未参保 HH 的平均（SD）住院次数为 0.82（1.75），CBHI 参保的为 1.13（1.56），有家庭保险的为 1.21（1.55）。在每个类别中，贫困 HH（财富指数最低五分位数）的医疗服务利用较低，而富裕 HH（财富指数较高五分位数）的医疗服务利用较高。在住院的人群中，CBHI 参保者发生灾难性健康事件的比例（7.9%）低于未参保者（12.3%）。在调整了社会经济地位和其他混杂因素后，我们的数据表明，参加 CBHI 计划增加了住院服务的利用几率（比值比 1.18；95%置信区间 1.04-1.33），并降低了灾难性健康支出的风险（比值比 0.52；95%置信区间 0.43-0.64）。
CBHI 计划提高了医疗服务的利用程度，并保护了那些住院的人免受灾难性的健康支出的影响。然而，在参保和医疗服务利用方面，也存在着一种社会经济梯度，有利于那些更富裕的人。
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