Essays on Health Insurance Impact and Coverage Related Disparities in India

Abstract

This dissertation project was aimed at evaluating health disparities that exist in health insurance programs in India and whether these programs have any impact on health service utilization and outcomes for the poor. I assessed these objectives through three independent manuscripts. In the first, I did an empirical analysis studying the effect of wealth status on health insurance enrollment. I found that primarily due to the newly introduced publicly funded health insurance schemes, the health insurance enrollment rates have improved for the marginalized caste groups. However, it was not clear what factors contribute to their higher enrollment rates. I have attempted to answer this question through the second manuscript of the dissertation. With this second manuscript, I analyzed data for India’s national health insurance scheme—Rashtriya Swasthya Bima Yojana (RSBY) and decomposed the enrollment differentials between the marginalized caste groups and the higher caste group. For the third manuscript, I assessed whether the maternal and child health (MCH) services indicators and child mortality outcomes improved after the implementation of the RSBY. For this empirical analysis, I used the difference-in-differences method to compare the selected MCH indicators for the poor versus the non-poor in the pre-and-post implementation period of the RSBY. Based on the results from the manuscripts, I argue that the poor, especially from the marginalized communities in India, are dependent on government programs for healthcare access. The federal and state governments should pay attention to the healthcare financing needs of these communities in future health insurance program implementation.