Vol. 06, Special Issue 05, (IC-LLCP-2021)July 2021 IMPACT FACTOR: 7.98 (INTERNATIONAL JOURNAL) AWARENESS REGARDING HEALTH INSURANCEIN BIHAR AND MEASURES TO
IMPROVE Manish Kumar
Research scholar, Department of applied Economics and Commerce Patna University, Patna, Bihar, India
Abstract- Healthy people have been the first and crucial requirement for a developed country. Health Insurance is a great emerging segment in Bihar. Above all mediclaim policy was launched in1986, evolution taken place from 1991and extreme change has been taken through the Ayushman Bharat scheme (2018) but still waiting for tremendous improvement of scope in this industry. The current effort attempts toevaluatethe citizen of the state about the awareness, challenges and preferences concerning HealthInsurance in Bihar. It is desirable by all but a major sectionof the population is not willing to spend on it.
The state health budget in 2017-18, 18-19, and 19-20 were 4.4%, 4.3% and 4.8%
respectively whereas, the average budget on health of all states was 5.3%. It shows that Bihar has the lowest budget provision. TheNITI Aayog professed rightly in 2019, that Bihar is the least healthy performing state in the country. Deficiency of awareness is due to the fact that more than 80% of people living in rural areas are less educatedand unaware about it.They are neither capable to approach agents nor willing to spend on it. If one wishes to avail, he or she finds that premium amount is not affordable. To spread out the awareness concerning health insurance in the state, along with insurance companies the state government have to work out and consistent change in their efforts. There is a need to be mandatory Health insurance in the state.
I. INTRODUCTION
The most hazardous pandemic Covid-19 has been proven all over the world that Healthy people have been the first and crucial requirement for a developed country. Thereforenow the popular saying“Health is wealth” ought to be changed as “Health is everything”.
Health contains physical as well as mental accuracy of an Individual of a country.Similarly, most of the peoplehope to be well-being and active mind, in spite of the fact,every time we need to handlenumerous situations willingly or unwillingly which critically affect our mental and physical health. Sometimes these health threats has become very dangerous andcapable to collapse the whole family physically, mentally and economically too, such as corona virus has exposed and changed whole world phenomena.
In order to reduce the burden of health care and save the life, citizen of the state have only a way to avail a health insurance policy and live burden less life.For this along with insurance companies the governments still needto introduce some hard measures or inforcesome mandatory or universal health insurance schemes for each and every citizen to live healthy and wealthy life.
Health Insurance is a combination of two words - health and insurance where insurance is a safeguard of health but it is quite different from Life Insurance. It provides a cover of indemnity to the affected policy holder against the medical expenses partly or in toto. In order to take advantage of the scheme one has to obtain health insurance policy and to pay a predetermined amount called premium.
As far as the Health Insurance is concerned the Nation is lagging behind the world. There areseveral reasons but ignorance and weak economic conditions have been the most effective. The Health improvement position of the state is very perilous not only in case of accidentbut also in the case of precarious diseases. Corona the pandemic has exposed the poor medical groundwork in India as well as in Bihar. Being the most backward and unhealthy state in India, Bihar stands in the extreme lowest position underthe NationalHealth index report. On the basis of a report of the Niti Aayog (June 2019) “Bihar is the least developed state in each and every sector. It further declares Bihar as the least healthy performing state in India”.
It is a collective concern for the governments and people of the state. Many Programmes and schemes have been launched by the successivestate of industries but the situation is still very deplorable. The Then Union Minister of Health and family welfare Dr. Harsh Vardhan to inaugurating the National Health Assurance Mission in July 2015
declared that the Government haveto “assure” every Indian individuals with suitable health care. Subsequently, in September 2018, Pradhan Mantri Jan Arogya Yojana (PM- JAY) or“Ayushman Bharat” was launched. It is estimated to prove a Milestone for the families living under BPL (below poverty line) and the government is also expecting to build a history in the field of Health Insurance in the state but also in the whole country.Despite,the middle class is not very much excited because they are excluded to take advantage of this schemes. Thereforefor both lower class and middle class immediately need Health Insurance policy toestablished Bihar as a healthy state. There are 38 districts in the state.Only 20 out of 38 districtshave hospitals tagged with various health insurance providers enablingcashlesstreatmentfacilityto their policyholders.
About105 health insurance providers attached hospitals are available in the state while 55% network hospitals are accessible in Patna and only 45% in left behindall districts.
Conversely more than 5000 companies attached hospitals are available all over the country.
Therefore extensive scope of investment opportunities and measures to improve awareness indicators are organised in the state to be gripped bypublic as well as private health insurance providers. This paper will scrutinize the causes of less acceptance of Health Insurance facilities in Bihar and will suggest measures to improve rapidly.
1.1 Expansion of Health Insurance
The incorporation of health insurance in India is traced out from Workmen's (personnel) Compensation Act, 1923; The Employees' State Insurance Act; In 1948, the first government funded health insurance scheme of the country, the “Employees State Insurance scheme” (ESIS) has been introduced for the blue collared private zonepersonnel.
Consequently, the “Central Government Health Scheme” has been launched in 1954 for central government personnel and their dependents. At that timethe government approved the General Insurance Business Act much later in 1972 and General Insurance was nationalized in 1973. The Government of India amalgamated one hundred seven insurers under four companies, they were the National Insurance Company Ltd, the United India Insurance Company Ltd, the New India Assurance Company Ltd, and the Oriental Insurance Company Ltd. When 'Mediclaim' policy was first launched in 1986 by the Indian government it’s offered minimum health coverage of INR ₹15,000 and maximum coverageof₹5 Lakh respectively. In the inauguration, healthinsurance cover only for individual citizens and their families in India then it offered reimbursement for hospital carethrough certain terms and conditions.
A radicalalterationtaken place when the economic reforms in 1991. Health insurance segment wasunlocked for private insurance companies. A commissiondirected by the former Governor of Reserve Bank of India, RN Malhotra, offered recommendations to regulate the insurance sector in India. The Insurance Regulatory Development Authority Act wasapproved in 1999 to regulate the insurance undertakings in India. The health insurance industryought tostart under the involvement of private and foreign company. In 2003, the Indiangovernment has also launched Universal Health Insurance for the individuals depressed Below Poverty Line. Anenormous health insurance programs have been abstracted for the bottom of pyramid population since 2007 and sponsored by both central and state government. From the time when, the government has been launching affordable health insurance programsbut not coveredthe whole population of the country because not permissible to each and every section of people.
The National Health Insurance Program (RashtriyaSwasthyaBima Yojana- RSBY) is directed by the Ministry of Health & Family Welfare thathas been adopted by 29 states in the year 2014. It is funded by the central at 75%and by the state governments at 25%.
The worker and his dependents (maximum four persons) avail benefit from health insurance if they live under below poverty line and not covered in any furthersystem.
Beneficiaries ofRSBY required to pay as per Annam registration fee of INR ₹30 for hospital coverage up to INR ₹30,000 yearly per family.On September 25th, 2018,“Mr.Narendra Modi” the Prime Minister of India declared to introduce a new health insurance pattern for the poorest people and projected to spread more than 50 crore people called “Modicare”
that later named as Pradhan Mantri Jan Arogya Yojana (PM-JAY) or AYUSHMAN
Vol. 06, Special Issue 05, (IC-LLCP-2021)July 2021 IMPACT FACTOR: 7.98 (INTERNATIONAL JOURNAL) BHARAT.Upgradation is stillon-going. Theaim to establish universalhealth insurance program in the countryis remains a delusion.
2. OBJECTIVESOF THE STUDY
To appraise from every section of households about the awareness, challenges and preferences of Health Insurance in the State.
To evaluate the various methods of awareness, buying patterns and willingness to
invest money on health insurance in Bihar.
To justify the several terms & conditions and claim settlement procedures of health
insurance providing companies on behalf of customers.
To ponder how to provide the efficient and effective health insurance services through various companies and governments.
To discover the appropriate methods to improve and encourage the citizen’s buying pattern of health insurance in Bihar.
3. HYPOTHESISOF THE STUDY
Thestudyproceeds with thefollowing hypothesis:
Hypothesis0:The level of awareness among the people is very high in Bihar.
HypothesisA: The level of awareness among the people is very low in Bihar.
4. REVIEW OF LITERATURE
Ravi Kant Sharma (2011) in his paper, “A comparison of health insurance Segment-India vs. China” seeks to compare both the economies India and china on health insurance aspect. Both economies have huge potential of healthinsuranceand45% of world’s population lives in both the countries.
R. Amsaveniands Gomathi (2013) made an attempt to find out mediclaim policy holder satisfaction, to recognize the reason for preferring mediclaim policy to safeguard themselves and stay away from future risk, majority of the respondents have taken personal scheme to employees. The major problems faced by the respondents are lack of timely communication and limited list of hospitals covered by the health insurance providers.
Sonal Kala(2015) study that respondents are aware about health insurance but denied to take health insurance or mediclaim policies. People have trust more on public general insurance companies rather than private general insurance companies to avail the health insurance policies. Respondents were not much aware regarding health insurance policies terms and conditions and according to them health insurance companies are not transparent.
Shivany M Vinoth(2018) Health insurance should be made mandatory all over India. There should be a basic policy mandatory for the population. But for the poor people who fall below the poverty line (BPL), they should be insured through any of the NHIS schemes as they offer very minimal premium. The employers who are unable to afford the health insurance schemes for their employees can issue a joint cost sharing, where both employee and employer will contribute. The employee's contribution can be fixed at a minimal level. This initiative is proven to have brought substantial improvement in the coverage in countries like China. Thus, India can also implement this method.
5. Measures to Improve Awareness Level of Health Insurance:-
1. Advertisement: These days, Advertisement has become an important part of our lives. We take many decisions for our future on the basis of this. It is the most effective source to aware anyone, anywhere and anytime. In case of product marketing, it helps in transmitting all type of information to the last consumer.
Even the matter of health insurance awareness, companies must focus on advertisement to encourage the people to take a health insurance policy. Similarly, more and more people will be aware to take health insurance with the help of advertisement. Therefor increasing in buying pattern of health insurance, people have to aware through TV, Radio, News, Journals/ Magazines, Banner/ Poster, Citation, Movies etc. As for as health insurance is concern, “policy bazar.com,
gibl.in, insurancedekho.com are doing admirable work in this field. A drastic change has been taken place in this sector and making well growth profit.
2. Social meet: Social meet is also very important source to aware each and every people of the state. There are many people who neither see advertisement nor trust on it. People can be influenced to buy health insurance through social gathering.
Hence, people can encouraged to buy health insurance by social meeting as;
Conference, Seminars, Road Shows, Human chain, Fair & festivals, Street shows and Schools & Colleges.
3. Friends and relatives: For any kind of awareness, the role of friends and relatives is important. With the help of these people, health insurance can also be expanded.
Some people do not want to take health insurance even thinking that their friends and relatives have not been taken. But they forget that the health problems can happen to anyone. Crisis never come through seeing cast – religion, good – bad, rich – poor and friend – relatives etc. Hence, through friends and relatives will be helpful to aware maximum family to take health insurance policy.
4. Government policies: This is the most important source to aware the entire country easily because government policy have to follow each and every people.
75% population of the state resides in the village. A large part of the citizen of the state go to work in other states. For all this, the government needs to take an important step. The government needs to bring a mandatory policy for all so that all the citizens of the state would connect. A common health insurance policy needs to issues by the help of government, chief and best policy will fulfil the basic urgent needs of the people. Just as people get vehicle insurance for fear of heavy fine, the need is also to apply to compulsory health insurance on the citizen. This will greatly benefit the government spending on government hospitals, medicine and doctors will also be reduced. Because all the people of the state will get their treatment done by the health insurance company. This will raise the spirit of competition in the government hospital and improve their service.
5. Company policies: Looking at the policies of the companies immediately, it can be said that much research is still needed on health insurance. Because till now companies in Bihar are either making policies for the upper classes only or are waiting for a new order from IRDA or the Government. So that after the order comes, the policy would be reached to the last person in the state. Companies may enhance the awareness as providing Incentives to policy holder, Rebate in renewal policy, Introducing saving linked Insurance, Introducing policy at minimum rate, Sponsored by company etc.
6. RESEARCHMETHODOLOGY
Empiricalresearch has been taken in to consideration under this research.Theprimary datahas been collectedfrompeople throughaquestionnaire format.The Secondary datahas beencollectedfromdifferentsources; newspapers, website, magazine, health insurancebulletins, national & international journals, and books.
Type of Research: - Empirical research
Technique of Sampling:-Simple Random Sampling
Sample Unit: -Mainlyfocused on PU adopted 5 villagesand rest 4 districtsofBihar Sample Size:-250
Tools forData Collection: -Questionnaire(Open endedand Close ended questions) Tools forData Analysis: -Question wiseFrequencypercentagetest and applied Relative Importance Index Method (RIIM) to find out the level of awareness on health insurance.
The Questionnaires have been categorisedand analysed on the basis of the objectivesoftheresearch.
7. ANALYSISANDINTERPRETATION OF DATA
The health budget of the state in 2015-16, 16-17, 17-18,18-19,and 19-20 were 4.1%, 5.4%, 4.4%, 4.3% and 4.8% respectively while the average health budget of the all states was 5.3%. It shows that Bihar govt spend lowest amount of total budget on health.
Vol. 06, Special Issue 05, (IC-LLCP-2021)July 2021 IMPACT FACTOR: 7.98 (INTERNATIONAL JOURNAL) The NITI Aayog brings out a Healthy States Progressive Report of India in June 2019. The report revealsthat Bihar is the least healthy performing state in Indiaand places it on the 20thout of 21strank.
To understand the scenario of Health Insurance and Awareness among the people of Bihar,we conducted a surveyin 2019 among 200 respondents from different class, age groups, gender, education, occupation, and income groups.Survey reveals that 75%
respondents were male and 25% were female. 60% respondents’ were up to 40 years age and rest 40% wasover 40 years age.
1. Educational qualification percentage of the respondents
2. Do you know about Health Insurance?
22%
36%
31%
11%
Illiterate Up to Matric Up to Graduation PG and Above
Yes, but I don’t have taken
No, not Aware Employer medical facilated
Yes and I have taken 35
55
5.5 4.5
70
110
11 9
Percentage Frequency
3. Do you know about AYUSHMAN BHARAT / Pradhan Mantri Jan Arogya Yojana?
4. Do you think that health insurance is important for us?Answer in five point likert's scale from Strongly Agree to Strongly Disagree.
Collected data presented on the five point Likert’s Scale ranging strongly agree to strongly disagree
Questions/ variables Strongly
Agree Agree Indifferent Disagree Strongly Disagree
a. Yes, it's important 17 85 85 14 4
b. don’t think so 3 2 4 28 168
c. Yes, but not as food, depends on
Income 117 50 28 9 1
d. can’t say because not aware 82 31 73 16 3
e. No because I can manage 4 1 50 123 27
Table no. 4.1
This question is significantly related to know the opinion of the respondents regarding importance of health insurance in the State. To find out the relevant outcome of this question, this must be taken into consideration to Analyze and interpret the above presented data through the Relative Important Index Method.
8. RELATIVE IMPORTANCE INDEX (RII) METHOD
The relative importance index (RII) method factors analysis was certified as the relative importance of uncertainty prior to ranking. Many types of sampling technique have been applied before selecting this methodology. The objectives of this methodology is to find out too many observation in one experimental period. This technique is generally used to analyze the significant of each variables weightage. At the time of evaluating the variables significant values the Relative Importance Index (RII) formulae applied to get actual importance value. There are three steps used in analyzing the data:
a) Tabulating and summarizing all the variables response to find out the relative importance index value;
b) Find out the Rank values of each variable factors on the basis of total product of relative importance index, and
c) To determine degree of correlation on ranking the factors among total variables (statement of questions).
Now it is important to compare from one statement to others given in the question.
Relative Importance Index values range lies between 0 - 1 While, the higher value will be 1. For each set of variables the RII value could be seen in the table. The contribution of each of the factors to universal delays were examined and the ranking of the quality in terms of their criticality as recognized by the respondents were done by applying the Relative Importance Index. This was computed to use an equation and the outcomes of the analysis are presented in Tables 1 to 3. To determine the ranking of different factors
Yes but not benefited
No, not aware Yes and I have benefited
Rashan card available only
31.5 36
8.5
24
63 72
17
48 Percentage Frequency
Vol. 06, Special Issue 05, (IC-LLCP-2021)July 2021 IMPACT FACTOR: 7.98 (INTERNATIONAL JOURNAL) from the viewpoint of counsellor and contractors, the Relative Importance Index was determined to use RII Equation by (AbdallaOdeh and Hussein Battaineh, 2002; Murat Gunduz et al., 2013; and Muhwezi and Otim, 2014).
Multiplying the collected data in 5, 4, 3, 2, 1 respectively with each value (SA x 5, A x 4, I x 3, D x 2, SD x 1)
Questions/ Variables SA x 5 A x 4 I x 3 D x 2 S D x 1
a. Yes, it's important 17 85 85 14 4
b. don’t think so 3 2 4 28 168
c. Yes but not as food, depend on Income 117 50 28 9 1
d. can’t say because not aware 82 31 73 16 3
e. No because I can manage 4 1 50 123 27
Table No. 4.2
The above table is showing the first step to calculate the product of the collected data. Each variable (questions) will use to multiply with their relevant wait which have been mentioned on the top of the table. It will be multiply with 5 in each variable of strongly agree, multiply with 4 in each variable of Agree, multiply with 3 in each variable of Indifferent, multiply with 2 in each variable of Disagree and strongly disagree will remain constant because it will multiply with 1 which does not affect any change in data set.
8.1 Total product value of each variables (Questions)
Table no. 4.3
After calculating the total value of each variables, this table will consider to determine relative important index value for interpretation. This table is also showing that each variable have five different answers. That answer must be multiplied with their relevant wait that is 5, 4, 3, 2, and 1. Each and every multiplied value of a variable have been summarized. All the summarized value of the variables will be used to get RII Rank.
Computation of Relative Important Index Rank Table no. 4.4
Table no. 7.9 is showing how the Relative Important Index ranks are computed. Total product of this experiments have been collected to determine the proper rank. Through the above ranks we will able to satisfy the hypothesis. The RII value have been computed by the following formula.
Relative Important Index = 5n5 +4n4 +3n3 + 2n2 + 1n1
A x N
Whereas,n5 = Number of respondents for Strongly Agree n4 = Number of respondents for Agree
Variables SA x 5 A x 4 I x 3 D x 2 SD x 1 Total
a. Yes, it's important 85 340 255 28 4 712
b. Don’t think so 15 8 12 56 168 259
c. Yes, but not as food on income 585 200 84 18 1 888
d. Can’t say because unaware 410 124 219 32 3 788
e. No because I can manage 20 4 150 246 27 447
Total Product Total No. A x N RII Rank
712 205 1025 0.695 3
259 205 1025 0.253 5
888 205 1025 0.866 1
788 205 1025 0.769 2
447 205 1025 0.436 4
n3 = Number of respondents for Indifferent n2 = Number of respondents for Disagree
n1 = Number of respondents for Strongly Disagree A = Highest Weight = 5
N = Total number of respondents = 205.
From the above formulae we need to calculate the final step of this method. This step will clearly conclude the experiment of the question. There after we need to calculate the data through another method. Both of the methods are co-related to each other which provide more significance and accurate results.
8.2 Relative Importance Index
Relative importance Index range between zero to one Questions/ Variables Relative importance
index value Importance
a. Yes, it's important 0.6946 3
b. Don’t think so 0.2527 5
c. Yes, but not as food, depends on Income 0.8663 1
d. Can’t say because not aware 0.7688 2
e. No because I can manage 0.4361 4
Table no. 4.5
Now, it is important to know the actual outcome of this experiment. There were five variables in the Relative Importance Index Technique. All the Important value have been traced out rank wise. It was found that 1st rank has been given to strongly agreed and said, “Yes, important but not as food”, “It depends on our income” because without income, even we cannot fulfil our basic needs then how we would pay premium for health insurance. 2nd rank has been given to simply agreed and sad, “can’t say because not aware”. 3rd rank has been given to indifferent and said “Yes It is Important”. 4th rank has been given by the people to disagree and said “No because I can manage”. And 5th, the last rank has been given to strongly disagreed and said “Don’t think so”. Thus all the variables importance results declared.
After all the level of awareness is very low in Bihar. People are not buying Health insurance policy due to greatscarcity and willingness to spend money for this or they are awaiting for low rate of premium. Therefore maximum people are not able to afford premium of health insurance. The RII Average value are showing that very few people wants to manage without health insurance.
5. Why have you not taken Health Insurance policy?
Vol. 06, Special Issue 05, (IC-LLCP-2021)July 2021 IMPACT FACTOR: 7.98 (INTERNATIONAL JOURNAL) 6. Do you have any Health Insurance policy?
7. Do you agree that the services provided by the insurance companies are effective?
8. Do you think that health insurance should be mandatory by the government?
48
19.27
13.49 11.68 7.56
Unaware about it
Low salary/non availability of
funds
Too costly and not refundable
Don’t feel the need for it
Don’t like to buy
Percentage
4.5
81.5
5.5 8.5
a. Yes b. No c. Employer's facilitatedd. yes, Ayushman
14.29 11.43
28.57
45.71
a. Yes b. No c. Can’t say d. Would improve
percentage
9. FINDINGS
After studying the above stated points & analyzed part, found that:-
Data belonging to to analyzed Education and Health both are equally important for awareness of health insurance and playa vital role inimprovementof insurance sector. As far as health insurance is concerned, Bihar is lagging behind the literacy of national average and higher education.This is because thelow level of awarenesson health in state which is clear in the survey.The NITI AYOG is also confirming the situation in the SDG index 2019 report of India.
It is a matter of seriousconcern that 55% respondents have no knowledge about Health Insurance.Few of them may have knowledge about Life Insurance but Health Insurancewasabsolutely new for them. Small parts (35%) of the respondents may havethe knowledge of Health Insurance but still they do not have purchased the policy.5.5% are availing medical facilitiesthrough theirproprietor and rests 4.5% are insured.
Question no.3 shows that 8.5% respondents are availing Ayushman Bharatyojana scheme and 24% respondents have rashan card and they were also eligible for the scheme. It also shows that Governmentought toplanto arrange some schemes for rest 67.5% of the citizen who deserve but not eligible to avail the schemes.
It was found that the 1st priority is given by the respondents that “health insurance is important but not as food”, “It depends on our income”. The 2nd importance has been given that they “can’t say because not aware”. The 3rd rank has been given that
“Yes It is Important”. The 4th importance has been given that “No because I can manage”. And 5th, the last importance has been given that “Don’t think so”.
It wasfound that 48% respondents were not availing the scheme because they were facing great difficulty to approach agents; no one suggested them to avail even friends andrelatives. 19.27% respondents have low salary or non-availability of funds. 13.49% respondents blamed about high premium, not refundable, narrow policy options and lack of reliability & flexibility. They have not purchased the policy and they would like to invest in some other field. 11.68% said that we do not feel the need and rest 7.56% respondents don’t like to buy because they can manage it.
Question no. 6 discover that total 81.5% respondents do not have any type of health insurance that showsexcessivenegligence among the respondents.
It has been alsoconsidered that only 14.29% respondents werepleased with the insurance provider’sservices and their terms & conditions,11.43% not pleased, 28.57% not answered because they were recently insured and 45.71% alleged it would improve.
Unexpectedlyalmost 96.07% accusedwereof the view that health insurance should be made mandatory or universal for all.Amongst 65.45% were agreedthat it should be mandatory from birth and 21.21% consent that it should be mandatory like Aadhar.
0 20 40 60 80 100
a. Yes mandatory b. Don’t think so 87.5
12.5
Percentage
Vol. 06, Special Issue 05, (IC-LLCP-2021)July 2021 IMPACT FACTOR: 7.98 (INTERNATIONAL JOURNAL) 10 CONCLUSION
In this period, we must consider that in our life trade “Health is Capital while Health insurance is return on investment”. It is proving a shelter to all over the world but people are not very much attentive in Bihar. Hence, Inexperience feeble economic disorders and not willing to spendon health insurance are most accountablereasonsto obstructing health perception in this state. Education, Income and Methodologiesadopted are very useful to increase the level of awareness. Health Insurance providers required to improve their services and spread their branches around the state. They must present some inexpensive, convenient and affordablehealth insurance plan for deprived society. The Government ought to make a universal Health Insurance scheme or mandatory for all.WholeBPL families must be facilitated from AyushmanBaharat health insurance scheme introduced by the central government. The underprivilegedpopulationunable to afford the health policy, should also be patronized by the Government to purchase health insurance policy.
BIBLIOGRAPHY
1. My article published in https://www.jetir.org on August 2020 and also taken from my Thesis “A Study on Awareness of Health Insurance in Bihar”
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