Table 10 Utilization of health services

HEFs

Increased utilization rates for the poor [86]

SUBO

No increased utilization rates for the poor [57]

URBMI

China Health and Nutrition Surveys of 2006 and 2009: significant increase of utilization of outpatient and inpatient care especially for children, members of low-income families and residents in the relatively poor western region [100]

NRCMS

Inconclusive evidence:

Increased use of preventive care (mainly physical check-ups)

No increased utilization of formal care [90]

Increased utilization of inpatient and outpatient services

For the poor greater utilization in outpatient services mainly concentrated on lower level (village/township) facilities [118]

RSBY

2.5 hospitalisations per 100 beneficiaries

Strong variations among different states (overall average for India: 2.3 for rural and 3.0 for urban regions) [121]

Yeshasvini

2003–2009: utilisation rate increased [65]

2.2 hospitalisations per 100 beneficiaries

Surgeries per 100 insured: 2003/4: 0.5; 2005/6: 1.2; 2007/8: 2.4

Outpatient visits per 100 insured: 2003/4: 2; 2005/6: 3.5; 2007/8: 8.62

Rajiv Aarogyasri

0.5 hospitalisations per 100 beneficiaries

Kalaignar

0.4 hospitalisations per 100 beneficiaries

45 % of claims are being made by women

Vajapayee Arogyasri

0.4 hospitalisations per 100 beneficiaries [12]

No significant increase in use of covered health services [130]

Indonesia

Increase for rural public health centres and urban public hospitals [61]

Only an estimated 60 % of beneficiaries used health services using their health insurance card in 2006 [93]

Slightly higher outpatient utilization rates of 16 % among Jamkesmas beneficiaries compared to contributors in formal sector scheme (14 %), local government managed Jamsostek scheme (14 %) and the non-insured (12 %) in 2010

Inpatient utilization rate of Jamkesmas beneficiaries are lower than that of Askes and Jamsostek enrolees—2.7 % compared to 4 and 3.3 % respectively, but higher than that of the uninsured (2 %) in 2010 [33]

Mongolia

Larger utilization among elderly, low-income and vulnerable groups

Low utilization among self-employed and students

Health service utilization quite similar across quintiles [49]

Philippines

Evidence for underutilization among subsidized [131]

2003 survey found 35 % of 5th income quintile and only 17 % of 1st income quintile used health services in the last 12 months

For the first quarter of 2009, 58 % of claims were filed by employed members, 18 % by individually paying members and 14 % by subsidized members, while membership shares were 48; 22 and 19 % respectively [63]

The hospital admissions rate among poor households is less than half that of the total population, and three times less than for the richest 10 % (for 2007) [35]

Thailand

Significant increase, especially in district health-care system; pro-poor distribution of service utilization [124]

Significant increase in utilization of outpatient and inpatient services after introduction of the UCS, particularly at primary care units and district hospitals [77]

Increased health care utilization especially among the previously uninsured

Overall outpatient and inpatient services among UCS members rose steadily from 2003 to 2011, with the outpatient utilization rate increasing from 2.45 to 3.23, and inpatient admission rate increasing from 9.42 to 11.40 %

2003–2009: significantly higher outpatient and inpatient utilization rates among the poorest quintile compared to richest quintile [36]

Still differences in average utilization rates across the three schemes:

Outpatient care utilisation rates in 2011: UCS—3.12; SSS—2.68: CSMBS—4.91

Inpatient utilization rates in 2011: UCS—0.11: SSS—0.05; CSMBS—0.16 [132]

Vietnam

Inconclusive evidence:

Increase in utilization, stronger for inpatient than for outpatient care; stronger for better-off, almost insignificant for poorest decile [53]

No change in utilization [133]

Lower utilization rates among poor and near-poor than the average utilization rates of all insured people [54]