Show simple item record

dc.contributor.authorDesai, S
dc.contributor.authorSinha, T
dc.contributor.authorMahal, A
dc.contributor.authorCousens, S
dc.date.accessioned2020-12-21T01:27:31Z
dc.date.available2020-12-21T01:27:31Z
dc.date.issued2014-07-26
dc.identifierpii: 1472-6963-14-320
dc.identifier.citationDesai, S., Sinha, T., Mahal, A. & Cousens, S. (2014). Understanding CBHI hospitalisation patterns: a comparison of insured and uninsured women in Gujarat, India. BMC HEALTH SERVICES RESEARCH, 14 (1), https://doi.org/10.1186/1472-6963-14-320.
dc.identifier.issn1472-6963
dc.identifier.urihttp://hdl.handle.net/11343/256519
dc.description.abstractBACKGROUND: Community-based health insurance has been associated with increased hospitalisation in low-income settings, but with limited analysis of the illnesses for which claims are submitted. A review of claims submitted to VimoSEWA, an inpatient insurance scheme in Gujarat, India, found that fever, diarrhoea and hysterectomy, the latter at a mean age of 37 years, were the leading reasons for claims by adult women. We compared the morbidity, outpatient treatment-seeking and hospitalisation patterns of VimoSEWA-insured women with uninsured women. METHODS: We utilised data from a cross-sectional survey of 1,934 insured and uninsured women in Gujarat, India. Multivariable logistic regression identified predictors of insurance coverage and the association of insurance with hospitalisation. Self-reported data on morbidity, outpatient care and hospitalisation were compared between insured and uninsured women. RESULTS: Age, marital status and occupation of adult women were associated with insurance status. Reported recent morbidity, type of illness and outpatient treatment were similar among insured and uninsured women. Multivariable analysis revealed strong evidence of a higher odds of hospitalisation amongst the insured (OR = 2.7; 95% ci. 1.6, 4.7). The leading reason for hospitalisation for uninsured and insured women was hysterectomy, at a similar mean age of 36, followed by common ailments such as fever and diarrhoea. Insured women appeared to have a higher probability of being hospitalised than uninsured women for all causes, rather than specifically for fever, diarrhoea or hysterectomy. Length of stay was similar while choice of hospital differed between insured and uninsured women. CONCLUSIONS: Despite similar reported morbidity patterns and initial treatment-seeking behaviour, VimoSEWA members were more likely to be hospitalised. The data did not provide strong evidence that inpatient hospitalisation replaced outpatient treatment for common illnesses or that insurance was the primary inducement for hysterectomy in the population. Rather, it appears that VimoSEWA members behaved differently in deciding if, and where, to be hospitalised for any condition. Further research is required to explore this decision-making process and roles, if any, played by adverse selection and moral hazard. Lastly, these hospitalisation patterns raise concerns regarding population health needs and access to quality preventive and outpatient services.
dc.languageEnglish
dc.publisherBMC
dc.rights.urihttps://creativecommons.org/licenses/by/4.0
dc.titleUnderstanding CBHI hospitalisation patterns: a comparison of insured and uninsured women in Gujarat, India
dc.typeJournal Article
dc.identifier.doi10.1186/1472-6963-14-320
melbourne.affiliation.departmentMelbourne School of Population and Global Health
melbourne.source.titleBMC Health Services Research
melbourne.source.volume14
melbourne.source.issue1
dc.rights.licenseCC BY
melbourne.elementsid1222129
melbourne.contributor.authorMahal, Ajay
dc.identifier.eissn1472-6963
melbourne.accessrightsOpen Access


Files in this item

Thumbnail

This item appears in the following Collection(s)

Show simple item record