Ambade Preshit Nemdas, Gerald Joe, Rahman Tauhidur
Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA.
Department of Community, Environment & Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85721, USA.
Healthcare (Basel). 2023 May 7;11(9):1343. doi: 10.3390/healthcare11091343.
Since 2005, health insurance (HI) coverage in India has significantly increased, largely because of the introduction of government-funded pro-poor insurance programs. As a result, the determinants of HI enrollment and their relative importance may have changed. Using National Family Health Survey (NFHS)-4 data, collected in 2015-2016, and employing a Probit regression model, we re-examine the determinants of household HI enrollment. Then, using a multinomial logistic regression model, we estimate the relative risk ratio for enrollment in different HI schemes. In comparison to the results on the determinants of HI enrollment using the NFHS data collected in 2005-2006, we find a decrease in the wealth gap in public HI enrollment. Nonetheless, disparities in enrollment remain, with some changes in those patterns. Households with low assets have lower enrollments in private and community-based health insurance (CBHI) programs. Households with a higher number of dependents have a higher likelihood of HI enrollment, especially in rural areas. In rural areas, poor Scheduled Caste and Scheduled Tribe households are more likely to be enrolled in public HI than the general Caste households. In urban areas, Muslim households have a lower likelihood of enrollment in any HI. The educational attainment of household heads is positively associated with enrollment in private HI, but it is negatively associated with enrollment in public HI. Since 2005-2006, while HI coverage has improved, disparities across social groups remain.
自2005年以来，印度的医疗保险覆盖范围显著扩大，这主要得益于政府资助的扶贫保险计划的推行。因此，医疗保险参保的决定因素及其相对重要性可能已经发生了变化。我们利用2015 - 2016年收集的全国家庭健康调查（NFHS）- 4数据，并采用Probit回归模型，重新审视家庭医疗保险参保的决定因素。然后，我们使用多项逻辑回归模型，估计不同医疗保险计划参保的相对风险比。与使用2005 - 2006年收集的NFHS数据得出的医疗保险参保决定因素的结果相比，我们发现公共医疗保险参保中的财富差距有所缩小。尽管如此，参保方面的差距依然存在，只是这些模式有了一些变化。资产较少的家庭在私人医疗保险和社区医疗保险（CBHI）计划中的参保率较低。受抚养人数较多的家庭医疗保险参保可能性更高，尤其是在农村地区。在农村地区，贫困的在册种姓和在册部落家庭比普通种姓家庭更有可能参加公共医疗保险。在城市地区，穆斯林家庭参加任何医疗保险的可能性较低。户主的受教育程度与参加私人医疗保险呈正相关，但与参加公共医疗保险呈负相关。自2005 - 2006年以来，虽然医疗保险覆盖范围有所改善，但社会群体之间的差距仍然存在。
