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Ahlin T, Nichter M, Pillai G. Health insurance in India: what do we know and why is ethnographic research needed. Anthropol Med. 2016;23(1):102-24doi: 10.1080/13648470.2015.1135787.
Ahlin, T., Nichter, M., & Pillai, G. (2016). Health insurance in India: what do we know and why is ethnographic research needed. Anthropology & medicine, 23(1), 102-24. https://doi.org/10.1080/13648470.2015.1135787
Ahlin, Tanja, et al. "Health insurance in India: what do we know and why is ethnographic research needed." Anthropology & medicine vol. 23,1 (2016): 102-24. doi: https://doi.org/10.1080/13648470.2015.1135787
Ahlin T, Nichter M, Pillai G. Health insurance in India: what do we know and why is ethnographic research needed. Anthropol Med. 2016;23(1):102-24. doi: 10.1080/13648470.2015.1135787. Epub 2016 Feb 01. PMID: 26828125.
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Anthropol Med. 2016;23(1):102-24. doi: 10.1080/13648470.2015.1135787. Epub 2016 Feb 01.

Health insurance in India: what do we know and why is ethnographic research needed.

Anthropology & medicine

Tanja Ahlin, Mark Nichter, Gopukrishnan Pillai

Affiliations

  1. a University of Amsterdam, Amsterdam Institute of Social Science Research , Nieuwe Achtergracht 166 , 1018 WV Amsterdam , the Netherlands.
  2. b School of Anthropology , University of Arizona , 1009 E. South Campus drive, Tucson , AZ 85721 , USA.
  3. c University of Leiden, Leyden Academy on Vitality and Aging , Poortgebouw LUMC, Rijnburgerweg 10, 2333 AA, Leiden , the Netherlands.

PMID: 26828125 DOI: 10.1080/13648470.2015.1135787

Abstract

The percentage of India's national budget allocated to the health sector remains one of the lowest in the world, and healthcare expenditures are largely out-of-pocket (OOP). Currently, efforts are being made to expand health insurance coverage as one means of addressing health disparity and reducing catastrophic health costs. In this review, we document reasons for rising interest in health insurance and summarize the country's history of insurance projects to date. We note that most of these projects focus on in-patient hospital costs, not the larger burden of out-patient costs. We briefly highlight some of the more popular forms that government, private, and community-based insurance schemes have taken and the results of quantitative research conducted to assess their reach and cost-effectiveness. We argue that ethnographic case studies could add much to existing health service and policy research, and provide a better understanding of the life cycle and impact of insurance programs on both insurance holders and healthcare providers. Drawing on preliminary fieldwork in South India and recognizing the need for a broad-based implementation science perspective (studying up, down and sideways), we identify six key topics demanding more in-depth research, among others: (1) public awareness and understanding of insurance; (2) misunderstanding of insurance and how this influences health care utilization; (3) differences in behavior patterns in cash and cashless insurance systems; (4) impact of insurance on quality of care and doctor-patient relations; (5) (mis)trust in health insurance schemes; and (6) health insurance coverage of chronic illnesses, rehabilitation and OOP expenses.

Keywords: Health Policy and Systems Research (HPSR); Health insurance; India; ethnography

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