Garg Samir, Bebarta Kirtti Kumar, Tripathi Narayan
State Health Resource Centre, Chhattisgarh, Raipur, India.
Arch Public Health. 2022 Apr 2;80(1):108. doi: 10.1186/s13690-022-00857-8.
Despite global guidance for maintaining essential non-Covid health services during the pandemic, there is a concern that existing services faced a major disruption. The access as well as affordability of healthcare could have suffered during the pandemic, especially in developing countries including India. There are no population based studies available in India on changes in access and financial risk for non-Covid hospitalisation during the pandemic. India has a policy of Publicly Funded Health Insurance (PFHI) to ensure access and financial protection for hospital care but no information is available on its performance during the pandemic. The current study was aimed to find out the change in access and financial protection for non-Covid hospitalisations during the Covid-19 pandemic and to examine the performance of PFHI in this context.
Panel data was analyzed, from two rounds of annual household surveys conducted in Chhattisgarh state for year 2019 and 2020. The survey followed a two-stage population based sample of around 3000 households, representative for the state. Two kinds of measures of catastrophic health expenditure were used - based on annual household consumption expenditure and on non-food consumption expenditure. Multivariate analysis was carried out to find determinants of utilisation and spending. In addition, Propensity Score Matching method was applied to find effect of PFHI schemes.
Utilisation of hospital care per 1000 population reduced from 58.2 in 2019 to 36.6 during the pandemic i.e. in 2020. The share of public hospitals in utilisation increased from 60.1% in 2019 to 67.0% in 2020. Incidence of catastrophic expenditure was significantly greater during the pandemic. The median Out of Pocket Expenditure (OOPE) in private hospitals doubled from 2019 to 2020. The size of OOPE and occurrence of catastrophic expenditure were significantly associated with utilisation in private hospitals. Enrolment under PFHI schemes including the Ayushman Bharat-Pradhan Mantri Jan Arogaya Yojana (PMJAY) was not effective in reducing OOPE or catastrophic expenditure.
While the utilisation of hospital care dropped during the pandemic, the private hospitals became further unaffordable. The government policy for financial protection through health insurance remained ineffective during the pandemic.
尽管在疫情期间有关于维持基本非新冠医疗服务的全球指导意见，但人们担心现有服务面临重大中断。在疫情期间，医疗保健的可及性和可负担性可能受到了影响，尤其是在包括印度在内的发展中国家。印度尚无基于人群的关于疫情期间非新冠住院治疗的可及性变化和财务风险的研究。印度有一项公共资助医疗保险（PFHI）政策，以确保获得医院护理并提供财务保护，但关于其在疫情期间的表现尚无相关信息。当前的研究旨在找出新冠疫情期间非新冠住院治疗的可及性和财务保护方面的变化，并在此背景下考察PFHI的表现。
对在恰蒂斯加尔邦于2019年和2020年进行的两轮年度家庭调查的面板数据进行分析。该调查采用了基于两阶段抽样的约3000户家庭样本，具有该邦的代表性。使用了两种灾难性医疗支出的衡量指标——基于家庭年度消费支出和非食品消费支出。进行多变量分析以找出利用情况和支出的决定因素。此外，应用倾向得分匹配法来找出PFHI计划的效果。
每千人口的住院治疗利用率从2019年的58.2降至疫情期间即2020年的36.6。公立医院在利用率中的占比从2019年的60.1%增至2020年的67.0%。疫情期间灾难性支出的发生率显著更高。私立医院的自付费用中位数从2019年到2020年翻倍。自付费用的规模和灾难性支出的发生与私立医院的利用率显著相关。包括阿育吠陀·巴拉特-总理全民健康保险计划（PMJAY）在内的PFHI计划的参保在降低自付费用或灾难性支出方面无效。
虽然疫情期间住院治疗的利用率下降，但私立医院变得更加难以负担。政府通过医疗保险提供财务保护的政策在疫情期间仍然无效。
