How Equitable is Employees’ State Insurance Scheme in India?: A Case Study of Tamil Nadu

Dash U, Muraleedharan VR, 2011 CREHS

One of the main objectives of a health system is to reduce the monetary cost of accessing health services, thereby enabling individuals with substantial unmet needs to access otherwise unaffordable care. Health insurance protects households against the financial burden of illness, especially large out-of-pocket expenses resulting from catastrophic illnesses, while at the same time raising additional resources for the public sector.

The purpose of this study is to analyse the health service utilisation of those enrolled in the Employees’ State Insurance Scheme (ESIS) and its role in protecting against catastrophic health payments in a low-income country setting. The study uses primary data collected through a semi structured questionnaire which sought detailed information on healthcare utilisation and spending and on other key individual and household factors. The questionnaire was administered by trained research investigators over the period August 2008 to March 2009.

The main results are surprising. ESIS is not found to provide financial protection against the risk of catastrophic payments, as the majority of the beneficiaries are seeking care outside the insurance plan from private facilities at a relatively high personal cost. This under use of ESIS services is due to; perceived low quality drugs, long waiting periods, impolite personnel, long delays in reimbursement of money spent on treatment from covered providers, and lack of or low interest of employers and low awareness of Employees’ State Insurance (ESI) procedures.

Research report | India | Financing