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 Methods1. 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 (%)

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Profile of Cases (1/2)

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No. Days in Hosp.

Yrs. with Insurance

Previous claims Age Reason for hosp’n

Claim paid(Rs.)

1 1 8 0 46 Viral Fever 995

2 2 3 0 48 Acute Gastro 1,973

3 2 4 0 35 Viral Fever 1,9154 2 4 0 41 Fever 2,0005 2 5 0 54 Viral Fever 3,977

6 2 6 1 (resp'y tract inf.) 32 Viral Fever 2,605

7 2 71 (husband's cataract)

54 Viral Fever 4,085

8 3 3 0 37 Viral Fever 1,5489 3 5 3 (RTI, VF) 35 Viral Fever 1,848

10 4 5 1 (uterine fibroid) 50 Acute Gastro 3,654

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 Factors1. 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

5. Provider moral hazard a possibility 11

Implications for Practice and Policy

Health Microinsurance

Include out-patient care?Only catastrophic illness?Sustainability vs. need

Health Systems – Quality of CarePoor quality of primary careShould insurance be a substitute for lack of universal health care?

Women’s Health and Health EducationNeed for education re. preventive and ‘promotive’ healthNeed for education re. symptoms, tests done, diagnosis, first line of treatment 12

Discussion Points

1. Future researchHow best can one integrate the health perspective into health microinsurance research?

2. Design of Health MI ProgrammeIs 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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