Investigator(s)
| WHO Technical Officer |
Grace Achungura WHO Country Office India Grace Achungura 
|
| Principal Investigator |
Maulik Choski Access Health International Maulik Choski
|
Title(s) and abstract
| Scientific title | Out-of-Pocket Expenditure (OOPE) Survey in Kerala |
| Public title | Out-of-Pocket Expenditure (OOPE) Survey in Kerala |
| Background | The State of Kerala has been a frontrunner in implementing health insurance schemes since 2007,with the Rashtriya Swasthya Bima Yojana (RSBY) and the Comprehensive Health Insurance Scheme(CHIS).In 2018, Kerala also transitioned to implement the PMJAY scheme and successfully converged the various insurance schemes into an integrated scheme calledarunya Arogya Suraksha Padathi (KASP). RSBY/CHIS, CHIS Plus, and Karunya Benevolent Fund (KBF) converged to form KASP, which aligned with the AB-PMJAY scheme. Kerala has expanded the overall population and service coverage through the implementation of the KASP scheme and thereby improving access to poor and marginalized sections of the population.Further, the state is also converging other similar programs to expand the current coverage of theKASP scheme. Hence, it is important to understand the program's impact on reducing out-of-pocket expenditure on health services and the demand side issues in scheme implementation. |
| Objectives | a) To determine the out-of-pocket expenditure levels among the beneficiaries of KASP-PMJAY scheme. b) To determine the perspectives of beneficiaries on the implementation of the PMJAY scheme. |
| Study Methods | The key objective of the survey is to understand the levels of OOPE among the KASP-PMJAY beneficiaries. Hence, we used two independent variables, the proportion of households in Kerala with at least one member insured and the proportion of out-of-pocket expenditure (OOPE) in Kerala, for calculating the sample size. The prevalence of households in Kerala with at least one member insured was 51.6% (NFHS-5, 2019-21), and the percentage of out-of-pocket expenditure (OOPE) was 68.6%. The total sample size is estimated to be 662, considering the largest of the two variables above, with 5% alpha error, 80% power, 15% non-response rate, and a design effect of 1.5. Kerala has three major geographical zones, i.e., North, Central, and South. One district from each of this zone will be purposively selected in consultation with the State Health Agency (SHA). Sample households from these districts will be selected using a multi-stage cluster random sampling method. Two rural local bodies (Gram Panchayats) and two urban local bodies (Municipal Corporations/Municipality) will be randomly selected from each district. Further, the wards in these rural/ local bodies will be randomly selected. The list of PMJAY beneficiaries in each ward will serve as the basis for the final selection of households for the survey. The OOPE survey tool will be adapted from the National Sample Survey (NSSO) Morbidity survey tool, and additional questions about the PMJAY treatment expenditure will also be included. The survey tool will be pre-tested, and necessary modifications will be made based on the pre-test findings. The draft tool is given as Annexure -1 |
| Expected outcomes and use of results | a) Representative estimates of levels of out-pocket expenditure amongst KASP PMJAY beneficiaries and non-beneficiaries b) Estimates of financial protection offered by the scheme. c) Evidence on the experiences of the patients utilizing the scheme. |
| Keywords | Out-of-pocket pocket expenditure, KASP, Financial protection, patient experience, patient satisfaction |
Research Details
| Student research | No |
| Start Date | 25-Aug-2023 |
| End Date | 15-Dec-2023 |
| Key Implementing Institution | Access Health International |
| Multi-country research | No |
| Nationwide research | No |
| India | |
| Research Domain(s) | Health Systems Research |
| Research field(s) | Health Financing |
| Involves human subjects | Yes |
| Population-Based Survey | |
| Data Collection | Primary data |
| Proposal reviewed by other Committee | No |