Here is the updated final answer. I have also included the articles I used.

How India finances their
healthcare system
Name
Institution affiliated

FINANCING INDIA'S HEALTHCARE
▪Out-of-pocket spending is exceptionally high in most SouthEast Asian countries
▪The total healthcare expenditure (THE) in India between 2013
and 2014 was 4.02 of its GDP (government spending
accounting for only 1.15% )
▪About 74.4% of the total private expenditure paid as OOP
(Shet et al., 2018)
▪Private financing accounts for over 80% of the overall health
financing
▪Health insurance covers only cater for up to 2% of the THE
(Garg, 2018).

PERSONAL REFLECTION
▪Healthcare spending is extremely low, government to find
ways of increasing healthcare budget
▪Makes the access to healthcare low, especially for low-income
families that have to rely on private insurance
▪The cost of healthcare is high, which contributes to increased
poverty in the country
▪Increasing public expenditure on healthcare will make services
more affordable, while also increasing the quality of care
▪More public expenditure will reduce out-of-pocket payments

REFERENCES
▪Garg, S. (2018). Universal health coverage in India: Newer innovations and the role of
public health. Indian journal of public health, 62(3), 167.
▪Shet, N., Qadiri, G. J., & Kalal, B. S. (2018). Impact of Out-Of-Pocket Health Care
Financing and Health Insurance Utilization among the Population: A Systematic
Review. International Journal of Health Sciences and Research, 8(2), 249-257.


From the SelectedWorks of B S Kalal

February 2, 2018

Impact of Out-Of-Pocket Health Care
Financing and Health Insurance
Utilization among the Population: A
Systematic Review
Nagaraj Shet
Ghulam Jeelani Qadiri
Bhuvanesh Sukhlal Kalal, Yenepoya University
Sunita Saldanha

Available at: https://works.bepress.com/bhuvanesh-

sukhlal-kalal/12/

International Journal of Health Sciences and Research
www.ijhsr.org

ISSN: 2249-9571

Review Article

Impact of Out-Of-Pocket Health Care Financing and Health Insurance
Utilization among the Population: A Systematic Review
Nagaraj Shet1, Ghulam Jeelani Qadiri2, Bhuvanesh Sukhlal Kalal3, Sunita saldanha4
1

Assistant Officer Operations, 2Professor, 4Associate Professor,
Department of Hospital Administration, Yenepoya Medical College Hospital, Deralakatte, Mangaluru-575018,
Karnataka, India.
3
Senior Research Fellow (CSIR), Department of Biochemistry, Yenepoya Medical College; and Yenepoya
Research Centre, Yenepoya University, Deralakatte, Mangaluru-575018, Karnataka, India.
Corresponding Author: Nagaraj Shet

ABSTRACT
The enactment of the insurance regulatory and development act (IRDA) in 1999 allows private and
foreign entrepreneurs to enter the health insurance market and at present Indian health insurance
sector offers different kind of health insurances like social health insurance, private health insurance
and community based health insurance etc. But even with this as depicted by many studies penetration
of insurance especially at rural India is very low and people are paying their heath care cost though
pocket.
To understand this issue, present article tries to provide detailed review on Out-of-pocket (OOP)
expenditure and their impact on the households, awareness and attitude regarding health insurance in
population. Using CINHAL, EBSCO Host and Medline databases the search was conducted for a
period of 4 months from February 2015 to May 2015. Most of the studies reported the OOP payments
on hose holds and role of health insurance on financial protection, health service utilization but less
often on quality of care, same time demonstrates lower level of awareness regarding health insurance
in rural population.
Review findings supports the view of entities like WHO that prepaid health financing mechanisms are
important alternative for OOP payment methods and which are capable to rule out the negative effects
of direst OOP payments and also helps to providing universal health coverage.
Key-Words: health care expenditure; Social health insurance; Out-of-pocket payment; India

INTRODUCTION
Out-of-pocket (OOP) expenditures
are the major health financing mechanism
across most of the South-East Asian and
other
developing
countries.
OOP
Expenditures are non-reimbursable fees
which a patient or family is responsible for
paying directly to health practitioners or
suppliers, without intervention of a third
party. It often occurs, when publicly funded
facilities are unable to provide the required
health services and supplies for free or
through insurance. [1,2] Often this OOP

expenditure poses a colossal burden on poor
households. [3] The costs are frequently high
enough so that households are unable to
recuperate them from existing resources,
and, hence, ultimately slip deeper into
poverty. As a result, protecting households
from catastrophic health expenditure
continues to remain as a formidable
challenge, particularly for countries with
high levels of poverty. [4]
India was ranked as having the 42nd
highest average OOPE, with 74.4 % of
private expenditure being paid as OOP. [5] In

International Journal of Health Sciences & Research (www.ijhsr.org)
Vol.8; Issue: 2; February 2018

249

Nagaraj Shet et al. Health Insurance an Alternative for Out-Of-Pocket Health Expendetires

the year of 2012, India ranked third in the
World Health Organization's latest list of
"countries with highest OOP expenditure on
health" in the south-east Asia region. [6]
Over 80% of the total health financing is
private financing, much of which takes the
form of OOP payments (i.e., user charges)
and not any prepayment schemes. [7] The
World Bank (2002) estimates that onequarter of all Indians fall into poverty as a
direct result of medical expenses in the
event of hospitalization. [8]
It is now widely acknowledged that
health care expenditures can impoverish
individuals and households. [9] The
discussion, debates and evidence around the
effect of OOP payments on health and
poverty outcomes was so intense that in
2005 the Member States of WHO adopted a
resolution encouraging countries to develop
health financing systems aimed at providing
universal coverage and The World Health
Organization (WHO) considers health
insurance a promising means for achieving
universal health-care coverage. [10] But,
penetration of Insurance in India is low due
to lack of awareness or state of functioning
of the available health insurance schemes.
[11,12]

To improve the knowledge, present
article evaluates OOP expenditure on health
and their impact on the households,
awareness and attitude regarding health
insurance in population and their source of
information, satisfaction level of the
population utilizing various health insurance
policies.
METHODS
In order to obtain the relevant
literature a search was made of three data
bases, CINHAL, EBSCO Host, and
Medline. The bibliographies of the selected
articles also revealed some relevant articles.
The search was conducted for a period of 4
months from February 2015 to May 2015.
All titles and abstracts of the initially
identified studies were screened to
determine if they satisfied the inclusion
criteria. Full text articles were retrieved for

the selected titles. Reference lists of the
retrieved articles, as well as previous review
articles, were searched for additional
publications.
Studies were included if they
(i)
Were randomized controlled trials,
cohort, case-control or cross-sectional
studies, or qualitative descriptive case
studies;
(ii)
Studies that were published any year
up to 2015.
(iii)
Studied the impact of OOP
catastrophic payment on house olds
(iv)
Studied the impact of health
insurance on resource mobilization,
financial protection
(v)
Studied the awareness, attitude,
satisfaction regarding health insurance
Studies were excluded if they:
(i) Were policy reviews, opinion pieces,
editorials, letters to the editor, commentaries
or conference abstracts.
(ii) Were duplicate references from different
databases.
The key words used in these searches were:
Health insurance, out of pocket (OPP)
payments, catastrophic payments, health
insurance knowledge and attitude.
RESULTS
From the initial search for peerreviewed articles based on title many were
excluded and only few full text references
were retained for further scrutiny. Detailed
inspection of abstracts and texts resulted in
only few quality articles. This includes
references
found
through
screening
reference lists in retrieved articles,
snowballing and additional screening of
organizational web sites .most studies used
an observational design and only a few used
a randomized controlled or other type
design.
Most of the studies reported
frequently on the impact of OOP payments
on hose holds and role of health insurance
on financial protection, health service
utilization but less often on quality of care,

International Journal of Health Sciences & Research (www.ijhsr.org)
Vol.8; Issue: 2; February 2018

250

Nagaraj Shet et al. Health Insurance an Alternative for Out-Of-Pocket Health Expendetires

same time demonstrates lower level of
awareness regarding health insurance in
rural population and stresses on need for
education on the co...