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Understanding Hospitalization
Among Insured Women
Tara Sinha and Sapna Desai
Self Employed Women’s Association (SEWA)
Research Conference on Microinsurance
University of Twente
April 11-13, 2012
Location of Study
The National Insurance VimoSEWA
Cooperative – Gujarat, India
– Voluntary MI scheme since 1992.
– Offers health, life, accident and asset
insurance
• Health microinsurance requires 24 hosp’n
– Aimed at women workers in the informal
economy and their families
– Urban and rural
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Research Issue and Question
• Research Issue: Higher rate of hospitalization
among insured compared to uninsured persons
• Research question: Does higher hospitalization
among insured urban women for common
illnesses mean improved access to health care
or unnecessary hospitalization?
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Data (1/2)
Mixed Methods
1. Study situated in a larger study
2. Baseline survey 954 insured and 980 uninsured
households in rural and urban areas – random
selection
3. Ten case studies of insured urban women hospitalized
for common illnesses – systematic sampling
4. Five doctor interviews
5. Administrative data from Vimo SEWA
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Data (2/2)
Issues examined in paper
1. Comparing insured and uninsured on
• Incidence of illnesses and common illnesses***
• Rates for all hospitalization
• Rates for hospitalization for common illnesses
2. Factors affecting hospitalization decision
•
•
•
Deterrents
Precipitating Factors
Facilitating Factors
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Baseline Survey Findings (1/2)
Urban adult women reporting illness in last month
and type of illness (%)
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Baseline Survey Findings (2/2)
Urban adult women reporting hospitalization in last 6
months and reasons for hospitalization (%)
6 4.7
(2.94 6.0
2.8
(2.23.4)
2
0
Insured
Uninsured
20
18
16
14
12
10
8
6
4
2
0
18
4
0
Fever
5
4
0
Diarrhoea Malaria
Insured
Uninsured
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Profile of Cases (1/2)
No. Days in Yrs. with
Hosp. Insurance
Previous claims
Age
Reason Claim paid
for hosp’n
(Rs.)
1
1
8
0
46
Viral Fever
2
3
4
5
2
2
2
2
3
4
4
5
0
0
0
0
48
35
41
54
Acute Gastro
Viral Fever
1,973
1,915
2,000
3,977
6
2
6
1 (resp'y tract inf.)
32
Viral Fever
2,605
7
2
7
1 (husband's cataract)
54
Viral Fever
4,085
8
9
10
3
3
4
3
5
5
0
3 (RTI, VF)
1 (uterine fibroid)
37
35
50
Viral Fever
1,548
1,848
3,654
Viral Fever
Fever
Viral Fever
Acute Gastro
995
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Case Study Findings (1/3)
Deterrents: Fear, Household disruption and costs
All had sought out-patient treatment at non-listed
hospital before hosp’n (except one acute case)
Precipitating Factors
- Minor persisting
inappropriate treatment
- Minor turning acute improper adherence
- Acute symptoms
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Case Study Findings (2/3)
Facilitating Factors
1. Insurance
– Insured going to listed hospital for consultation
– Insured more willing to be hospitalized
2. Providers’ Perspective
- Criteria for admission
- Perception of members as having poor living
conditions, poor awareness
- If patient willing, admission covers risk
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Case Study Finding (3/3)
Given:
a)Six of ten cases first time admissions
b)Two of four previous claims for non-common illnesses
c) Nine of ten cases sought out patient care at non-listed
hospital prior to hospitalization
d)Deterrents to hospitalization
1. Strong indication of poor quality primary care
2. Little indication of member moral hazard
3. Indication of insurance promoting health care seeking in
hospital/improved access
4. Adverse member selection a possibility
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5. Provider moral hazard a possibility
Implications for Practice and Policy
Health Microinsurance
Include out-patient care?
Only catastrophic illness?
Sustainability vs. need
Health Systems – Quality of Care
Poor quality of primary care
Should insurance be a substitute for lack of universal
health care?
Women’s Health and Health Education
Need for education re. preventive and ‘promotive’ health
Need for education re. symptoms, tests done, diagnosis,
first line of treatment
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Discussion Points
1. Future research
How best can one integrate the health perspective
into health microinsurance research?
2. Design of Health MI Programme
Is inclusion of out-patient care needed to prevent
hospitalization for common illnesses?
3. Health Education
Can health education prevent hospitalization for
common illnesses?
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THANK YOU
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