Dubey Sweta, Deshpande Swasti, Krishna Lokesh, Zadey Siddhesh
Association for Socially Applicable Research (ASAR), Pune, India.
Lalwani Mother and Child Care Hospital, Pune, India.
Lancet Reg Health Southeast Asia. 2023 Apr 5;13:100180. doi: 10.1016/j.lansea.2023.100180. eCollection 2023 Jun.
India has run multiple Government-Funded Health Insurance schemes (GFHIS) over the past decades to ensure affordable healthcare. We assessed GFHIS evolution with a special focus on two national schemes - Rashtriya Swasthya Bima Yojana (RSBY) and Pradhan Mantri Jan Arogya Yojana (PMJAY). RSBY suffered from a static financial coverage cap, low enrollment, inequitable service supply, utilization, etc. PMJAY expanded coverage and mitigated some of RSBY's drawbacks. Investigating equity in PMJAY's supply and utilization across geography, sex, age, social groups, and healthcare sectors depicts several systemic skews. Kerala and Himachal Pradesh with low poverty and disease burden use more services. Males are more likely to seek care under PMJAY than females. Mid-age population (19-50 years) is a common group availing services. Scheduled Caste and Scheduled Tribe people have low service utilization. Most hospitals providing services are private. Such inequities can lead the most vulnerable populations further into deprivation due to healthcare inaccessibility.
在过去几十年里，印度实施了多项政府资助的医疗保险计划（GFHIS），以确保人们能够负担得起医疗保健服务。我们评估了政府资助的医疗保险计划的演变情况，特别关注了两个国家计划——拉什特里亚·斯瓦斯蒂亚·比马约纳（RSBY）和普拉丹·曼特里·贾恩·阿罗吉亚约纳（PMJAY）。RSBY存在财政覆盖上限固定、参保率低、服务供应和利用不均衡等问题。PMJAY扩大了覆盖范围，并缓解了RSBY的一些弊端。对PMJAY在地理、性别、年龄、社会群体和医疗保健部门的供应和利用情况进行公平性调查，发现了一些系统性偏差。贫困和疾病负担较低的喀拉拉邦和喜马偕尔邦使用的服务更多。在PMJAY计划下，男性比女性更有可能寻求医疗服务。中年人群体（19至50岁）是享受服务的常见群体。在册种姓和在册部落人群的服务利用率较低。大多数提供服务的医院是私立医院。由于无法获得医疗保健服务，这种不公平现象可能会使最脆弱的人群进一步陷入贫困。
