Health Inc. (“Financing health care for inclusion”) is a 3.5 year (2011–2014) research project between LSE Health (project coordinator), the Institute of Tropical Medicine in Antwerp, Tata Institute of Social Science in Mumbai, Institute of Public Health in Bangalore, the Centre for Research on Social Policies in Senegal and the Institute of Statistical, Social and Economic Research in Ghana.
The project is funded by a €2.8 million grant from the European Commission’s 7th Framework Programme (Activity area: Socio-economic Sciences and Humanities).
Health Inc. employs mixed methods research techniques in Ghana, Senegal and the Indian states of Maharashtra and Karnataka to analyse whether different types of financing arrangements overcome social exclusion and increase social inclusion by empowering marginalised groups. The health financing schemes researched are the RSBY (Rashtriya Swasthya Bima Yojana) national health insurance scheme in India, the Ghanaian National Health Insurance Scheme (NHIS) and the Senegalese Plan Sesame.
There has been a recent proliferation of health financing reforms in low and middle income countries (LMIC) which aim to introduce prepayment at affordable prices for vulnerable populations. However, while such reforms have led to increased utilization of health care, it is often the case that the poor and informal sector workers continue to be excluded from coverage. Health Inc. puts forward the hypothesis that social exclusion is an important cause of the limited success of recent health financing reforms.
Firstly, social exclusion can explain barriers to accessing health care due to disrespectful or discriminatory practices of medical professionals and their organisations, within the context of poor accessibility and quality of care. Secondly, social exclusion can explain barriers to accessing the health financing mechanism itself. Differential access to information, bureaucratic processes, complex eligibility rules and stigmatizing criteria for means testing prevent socially excluded groups from enrolling in financing schemes, even if they are fully subsidised.
To explore how social exclusion restricts access to health services despite recent health financing reforms and to determine how social health protection for vulnerable groups can be increased.
Provisional results show that socially excluded groups suffer from inequities in access to the health financing schemes being studied due to a combination of social, political, economic and cultural factors.
Women, the elderly, the poor, those not partaking in local politics and those lacking social support networks are particularly disadvantaged. They are less likely to be aware of the various schemes, less likely to be enrolled and, when they do enrol, remain less likely to utilise health care.
Health Inc. will contribute to the success of health financing reforms by addressing equity and access in low and middle income countries in general and in Ghana, India and Senegal in particular, through an improved understanding of social exclusion.
The various obstructing and facilitating factors that affect access to health care financing mechanisms have been identified and policy options are being developed to address them. The scope for implementing these policy options at local, national and international levels is being explored through stakeholder consultations.
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