District-Level Patterns of Health Insurance Coverage and Out-of-Pocket Expenditure on Caesarean Section Deliveries in Public Health Facilities in India

Reducing catastrophic out-of-pocket expenditure (OOPE) and increasing the rates of institutional deliveries are part Sustainable Development Goals (SDGs). India has made significant progress on maternal child health front in recent years. India’s National Health Mission (NHM) been able to increase deliveries. In present study, we aim ascertain district-level patterns percentage insurance coverage Family Surveys NFHS 4 5. We also C-section public facilities The study explores data associated with (%) a facility (in INR) observed across A spatial analysis was carried out using QGIS 3.26 (Mac version) GeoDA 1.20.0.8. visual assessment maps 5 shows improvement at district level two surveys. Despite an coverage, North East experienced OOPE for Rajasthan various parts South have decrease Kerala rise Univariate LISA cluster significance revealed that Tamil Nadu, eastern coast Mizoram hot spots, whereas Jammu Kashmir Uttar Pradesh Gujarat cold spots. Both these findings significant. emerges as spot along Assam few districts Nadu Andhra Pradesh. Kashmir, Ladakh, Pradesh, Maharashtra, Karnataka emerged Indian states no longer spots indicating geospatial variations time. An number indicates rising C-sections despite growth coverage. does not offer any evidence suggest decreases government facilities. With RSBY having launched 2008 Ayushman Bharat 2018, high levels raise serious concerns about efficacy PFHIs reducing OOPE. would need plug well-documented weaknesses PFHIs, such fraud, double charging, poor enrolment, lack awareness addition unfortunate phenomena “tips” “tie ups” mentioned earlier plague healthcare system, if see reduction foreseeable future.