Background

The last decade has seen an exponential increase in the number of government-funded health insurance schemes in India as well as the number of individuals who have been protected under these schemes. The only channel that the beneficiaries have for expressing their concerns and suggestions is through a grievance redressal mechanism.

It is expected that this study will help in understanding the effectiveness of grievance redressal in assisting the beneficiaries in articulating their grievances and thereby helping the scheme managers in strengthening the scheme.

Objectives

To study the role of grievance redressal mechanisms in providing a voice to the beneficiaries in government funded health insurance schemes in India.

Methods

We propose to describe the workings of grievance redressal mechanisms in two different configurations of GFHI schemes in differing policy contexts, document how they function and to what extent they are useful in providing a voice to the patients. Using a realist evaluation approach, we shall conduct in-depth studies of two Indian GFHI schemes one a hybrid model and another a Trust Model.

About

The Indian government has been implementing various health insurance schemes in the last decade to provide financial protection to vulnerable sections of the society against health-related expenses. The implementation of these schemes has increased the number of individuals covered under health insurance. However, the beneficiaries of these schemes have limited channels to express their grievances and concerns, which can affect the quality of healthcare they receive.

The grievance redressal mechanism is an essential aspect of any health insurance scheme, as it provides a platform for beneficiaries to voice their concerns and receive solutions for their grievances. The grievance redressal mechanism includes a system of identifying, registering, and resolving complaints and grievances received from beneficiaries. This mechanism is crucial to ensure accountability and transparency in the delivery of healthcare services to beneficiaries.

This project aims to understand the effectiveness of grievance redressal mechanisms in providing a voice to beneficiaries in government-funded health insurance schemes in India. By studying the workings of grievance redressal mechanisms in two different configurations of GFHI schemes in differing policy contexts, the project aims to document how these mechanisms function and to what extent they are useful in providing a voice to patients.

The project will use a realist evaluation approach, which focuses on understanding the underlying mechanisms that drive the success or failure of an intervention. This approach allows for a deeper understanding of how the grievance redressal mechanism works and what factors contribute to its effectiveness or inefficiency. By examining the different configurations of GFHI schemes and the policy contexts in which they operate, the project aims to identify the factors that contribute to the success or failure of grievance redressal mechanisms in different contexts.

The two Indian GFHI schemes chosen for this study are a hybrid model and a Trust Model. The hybrid model is a combination of government-funded and private insurance schemes, while the Trust Model is entirely funded by the government. By comparing these two schemes, the project aims to identify the strengths and weaknesses of different grievance redressal mechanisms. This project is being funded by the Indian Council of Medical Research (ICMR), which will be carried out in two states, namely Andhra Pradesh and Gujarat, which are located in different regions of the country and have differing policy contexts.

For this project, the Institute of Public Health (IPH) Bengaluru is partnering with the Indian Institute of Public Health, Gandhinagar (IIPHG). The partnership between IPH Bengaluru and IIPHG will provide a unique opportunity to bring together the expertise of both institutions and leverage their strengths to conduct a comprehensive study on the effectiveness of grievance redressal mechanisms in government-funded health insurance schemes in India. The study will benefit from the experience and knowledge of researchers from both institutions, who have extensive experience in public health research, Health financing, evaluation, and policy development.

The findings of this study will be useful for policymakers and scheme managers to identify areas of improvement in grievance redressal mechanisms. By strengthening these mechanisms, beneficiaries can voice their concerns and receive appropriate solutions, which can ultimately improve the quality of healthcare services delivered under government-funded health insurance schemes in India.