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The impact of health insurance on hypertension care: a household fixed effects study in India

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Názov: The impact of health insurance on hypertension care: a household fixed effects study in India
Autori: Feng, Zixuan, Chen, Qiushi, Jiao, Lirui, Ma, Xuedi, Atun, Rifat, Geldsetzer, Pascal, Bärnighausen, Till, Chen, Simiao
Zdroj: BMC Public Health
BMC Public Health, Vol 24, Iss 1, Pp 1-12 (2024)
Informácie o vydavateľovi: Springer Science and Business Media LLC, 2024.
Rok vydania: 2024
Predmety: Adult, Male, Family Characteristics, Insurance, Health, Adolescent, Research, India, Care cascade, Middle Aged, Health Surveys, Health policy, Unmet needs, Insurance Coverage, Health Services Accessibility, 3. Good health, Young Adult, 03 medical and health sciences, Health insurance, 0302 clinical medicine, Hypertension, Humans, India [MeSH], Adolescent [MeSH], Female [MeSH], Hypertension/epidemiology [MeSH], Adult [MeSH], Humans [MeSH], Middle Aged [MeSH], Family Characteristics [MeSH], Insurance Coverage/statistics, Health Surveys [MeSH], Male [MeSH], Young Adult [MeSH], Hypertension/therapy [MeSH], Insurance, Health/statistics, Health Services Accessibility/statistics, Female, Public aspects of medicine, RA1-1270
Popis: Introduction Hypertension is highly prevalent in India, but the proportion of patients achieving blood pressure control remains low. Efforts have been made to expand health insurance coverage nationwide with the aim of improving overall healthcare access. It is critical to understand the role of health insurance coverage in improving hypertension care. Methods We used secondary data from the nationally representative sample of adults aged 15–49 years from the 2015–2016 National Family Health Survey (NFHS) in India. We defined the hypertension care cascade as four successive steps of (1) screened, (2) diagnosed, (3) treated, and (4) controlled, and operationalized these variables using blood pressure measurements and self-reports. We employed household fixed effect models that conceptually matched people with and without insurance within the household, to estimate the impact of insurance coverage on the likelihood of reaching each care cascade step, while controlling for a wide range of additional individual-level variables. Results In all 130,151 included individuals with hypertension, 20.4% reported having health insurance. For the insured hypertensive population, 79.8% (95% Confidence Interval: 79.3%-80.3%) were screened, 49.6% (49.0%-50.2%) diagnosed, 14.3% (13.9%-14.7%) treated, and 7.9% (7.6%-8.2%) controlled, marginally higher than the percentages for the uninsured 79.8% (79.5%-80.0%), 48.2% (47.9%-48.6%), 13.3% (13.1%-13.5%), and 7.5% (7.4%-7.7%) for each cascade step, respectively. From the household fixed effects model, health insurance did not show significant impact on the hypertension care cascade, with the estimated relative risks of health insurance 0.97 (0.93–1.02), 0.97 (0.91–1.03), 0.95 (0.77–1.30), and 0.97 (0.65–1.10) for each cascade step, respectively. We further performed stratified analyses by sociodemographic and behavioral risk factors and a sensitivity analysis with district fixed effects, all of which yielded results that confirmed the robustness of our main findings. Conclusions Health insurance did not show significant impact on improving hypertension care cascade among young and middle-aged adults with hypertension in India. Innovative strategies for overcoming practical barriers to healthcare services in addition to improving financial access are needed to address the large unmet need for hypertension care.
Druh dokumentu: Article
Other literature type
Jazyk: English
ISSN: 1471-2458
DOI: 10.1186/s12889-024-19759-1
Prístupová URL adresa: https://pubmed.ncbi.nlm.nih.gov/39175008
https://doaj.org/article/7f3d6b75ec8a470392b3f5080ebecb35
https://repository.publisso.de/resource/frl:6491708
Rights: CC BY
Prístupové číslo: edsair.doi.dedup.....73aa9bf1aa1745a0130a29116f7aa3bf
Databáza: OpenAIRE
Popis
Abstrakt:Introduction Hypertension is highly prevalent in India, but the proportion of patients achieving blood pressure control remains low. Efforts have been made to expand health insurance coverage nationwide with the aim of improving overall healthcare access. It is critical to understand the role of health insurance coverage in improving hypertension care. Methods We used secondary data from the nationally representative sample of adults aged 15–49 years from the 2015–2016 National Family Health Survey (NFHS) in India. We defined the hypertension care cascade as four successive steps of (1) screened, (2) diagnosed, (3) treated, and (4) controlled, and operationalized these variables using blood pressure measurements and self-reports. We employed household fixed effect models that conceptually matched people with and without insurance within the household, to estimate the impact of insurance coverage on the likelihood of reaching each care cascade step, while controlling for a wide range of additional individual-level variables. Results In all 130,151 included individuals with hypertension, 20.4% reported having health insurance. For the insured hypertensive population, 79.8% (95% Confidence Interval: 79.3%-80.3%) were screened, 49.6% (49.0%-50.2%) diagnosed, 14.3% (13.9%-14.7%) treated, and 7.9% (7.6%-8.2%) controlled, marginally higher than the percentages for the uninsured 79.8% (79.5%-80.0%), 48.2% (47.9%-48.6%), 13.3% (13.1%-13.5%), and 7.5% (7.4%-7.7%) for each cascade step, respectively. From the household fixed effects model, health insurance did not show significant impact on the hypertension care cascade, with the estimated relative risks of health insurance 0.97 (0.93–1.02), 0.97 (0.91–1.03), 0.95 (0.77–1.30), and 0.97 (0.65–1.10) for each cascade step, respectively. We further performed stratified analyses by sociodemographic and behavioral risk factors and a sensitivity analysis with district fixed effects, all of which yielded results that confirmed the robustness of our main findings. Conclusions Health insurance did not show significant impact on improving hypertension care cascade among young and middle-aged adults with hypertension in India. Innovative strategies for overcoming practical barriers to healthcare services in addition to improving financial access are needed to address the large unmet need for hypertension care.
ISSN:14712458
DOI:10.1186/s12889-024-19759-1