Article Text

Original research
Impact of public-funded health insurances in India on health care utilisation and financial risk protection: a systematic review
  1. Bhageerathy Reshmi1,
  2. Bhaskaran Unnikrishnan2,
  3. Eti Rajwar3,
  4. Shradha S Parsekar3,
  5. Ratheebhai Vijayamma4,
  6. Bhumika Tumkur Venkatesh3
  1. 1Department of Health Information Management, Manipal College of Health Professions, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India
  2. 2Department of Community Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
  3. 3Department of Health Information, Public Health Evidence South Asia, Prasanna School of Public Health, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India
  4. 4Manipal Institute of Communication, MAHE, Manipal, Karnataka, India
  1. Correspondence to Dr Bhumika Tumkur Venkatesh;{at}


Objective Universal Health Coverage aims to address the challenges posed by healthcare inequalities and inequities by increasing the accessibility and affordability of healthcare for the entire population. This review provides information related to impact of public-funded health insurance (PFHI) on financial risk protection and utilisation of healthcare.

Design Systematic review.

Data sources Medline (via PubMed, Web of Science), Scopus, Social Science Research Network and 3ie impact evaluation repository were searched from their inception until 15 July 2020, for English-language publications.

Eligibility criteria Studies giving information about the different PFHI in India, irrespective of population groups (above 18 years), were included. Cross-sectional studies with comparison, impact evaluations, difference-in-difference design based on before and after implementation of the scheme, pre–post, experimental trials and quasi-randomised trials were eligible for inclusion.

Data extraction and synthesis Data extraction was performed by three reviewers independently. Due to heterogeneity in population and study design, statistical pooling was not possible; therefore, narrative synthesis was performed.

Outcomes Utilisation of healthcare, willingness-to-pay (WTP), out-of-pocket expenditure (including outpatient and inpatient), catastrophic health expenditure and impoverishment.

Results The impact of PFHI on financial risk protection reports no conclusive evidence to suggest that the schemes had any impact on financial protection. The impact of PFHIs such as Rashtriya Swasthy Bima Yojana, Vajpayee Arogyashree and Pradhan Mantri Jan Arogya Yojana showed increased access and utilisation of healthcare services. There is a lack of evidence to conclude on WTP an additional amount to the existing monthly financial contribution.

Conclusion Different central and state PFHIs increased the utilisation of healthcare services by the beneficiaries, but there was no conclusive evidence for reduction in financial risk protection of the beneficiaries.

Registration Not registered.

  • health policy
  • health informatics
  • public health
  • epidemiology
  • quality in health care
  • organisation of health services

Data availability statement

Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. The datasets used and/or analysed during the current study are available from the corresponding author on request.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

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Data availability statement

Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. The datasets used and/or analysed during the current study are available from the corresponding author on request.

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  • Contributors RB is the guarantor of the review. BTV, ER, RB and SSP conceptualised the topic. RV developed search strategy and conducted the search. SSP carried out title/abstract screening and BTV, ER, SSP carried out full text screening. BTV, ER and SSP extracted first round of data extraction, analysed and synthesised the data for the review. Extracted data from all the included studies was cross-checked and independent extraction was done for one third randomly selected studies by BTV, ER, SSP. Quality assessment was performed by BTV, ER, SSP. BTV, ER, SSP drafted the first version of report, which was further edited by RB, BTV, ER, RV, BU and SSP. All the authors read, provided feedback and approved the final report.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.