Does Health Insurance Reduce Distress Financing for Caesarean Deliveries in India?

Ankita Roy, International Institute for Population Sciences (IIPS), Mumbai
Suraj Maiti, Virginia Tech
Rajeev Singh, International Institute for Population Sciences (IIPS)
Sanjay K Mohanty, International Institute for Population Sciences (IIPS)

An increase in caesarean delivery and its financial burden is alarming worldwide. Literature suggests a high economic burden of caesarean deliveries among the poor and marginalised population, but no study has examined the temporal change in distress financing for caesarean delivery and its association with health insurance. We have analysed 303,417 births from the last two rounds of NFHSs, 2015-16 and 2019-21. Distress financing was defined as those who meet out-of-pocket payments by borrowing money and selling assets. A multivariate logistic regression examined the association between health insurance coverage and distress financing. Our findings suggest that distress financing for caesarean delivery declined from 31·2% to 23·1% during 2015-21. The reduction of distress financing for caesarean delivery among insureds was 10%. The extent of distress financing was lowest among the employer or private health insured and was significantly associated with reduction in distress financing. The state pattern of caesarean delivery, health insurance coverage and distress financing were mixed. Daman and Diu, Goa, Lakshadweep, Karnataka, etc., state that there has been a huge decline in distress financing for caesarean deliveries. Employer and private health insurance are more effective than social health insurance in the reduction of distress financing for caesarean delivery.

Keywords: Sexual and Reproductive Health and Rights, Population Policies, Economic Demography, Health and Morbidity

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