Assessing geographical inequity in availability of hospital services under the state-funded universal health insurance scheme in Chhattisgarh state, India, using a composite vulnerability index

Figures & data

Figure 1. Conceptual framework illustrating pathways of equity under the universal health insurance scheme.

Table 1. List of indicators selected for developing the vulnerability index, along with the rationale for their selection.

Name of indicator	Dimension	Rationale for selection	Source of data
Proportion of Scheduled Caste (SC) and Scheduled Tribe (ST) population	Social vulnerability	Caste or social group is considered as a critical determinant of socio-economic vulnerability in India [7,8]	Registrar General of India. GoI [42]
Proportion of un-irrigated net sown area	Economic vulnerability	Rural poverty is much lower in irrigated than in rainfed areas [62,63]	Directorate of Economics & Statistics. GoCG [56]
Female illiteracy	Education and gender inequality	Education and gender inequality are important indicators of vulnerability [64–66]	Registrar General of India. GoI [42]
Proportion of rural population	Rural status	Rural populations are more vulnerable than urban [8]	Registrar General of India. GoI [42]
Year of formation of the district	Availability of infrastructure	The older districts would have better health and other relevant infrastructure and administrative capacity than newer districts established in the last few years [67,68]. For instance, in the newer districts, the district hospitals are still under the process of being established	Directorate of Economics & Statistics. GoCG [56]

Table 2. Indicators of the health insurance scheme.

Dimension	Indicators
Availability of empanelled hospitals	No. of hospitals empanelled per 100,000 persons enrolled
	No. of private hospitals empanelled per 100,000 persons enrolled
	No. of public hospitals empanelled per 100,000 persons enrolled
	Proportion of Private/Public hospitals empanelled to total empanelled
Enrolment	Proportion of census (2011) population enrolled
	Proportion of census (2011) Households enrolled
Number and amount of claims	Total no. of claims/amount of claims per 100,000 persons enrolled
	No. of claims/amount of claims by private providers per 100,000 persons enrolled
	No. of claims/amount of claims by public providers per 100,000 persons enrolled
	Proportion of number by Public/Private hospitals to total claims/amount of claims

Table 3. Vulnerability Index and insurance scheme indicators across districts.

SN	District	VI	Vulnerability tertile	Insurance scheme indicators
				Hospitals/100,000 enrolled population	Public hospital/100,000 enrolled	Private hospital/100,000 enrolled	No. of claims/100,000 enrolled population	No. of public claims/100,000 enrolled population	No. of private claims/100,000 enrolled population
1	Sukma	4.9	HVD	6.8	3.4	3.4	399	334	65
2	Bijapur	4.7	HVD	4.5	4.5	0.0	5628	5628	0
3	Narayanpur	4.5	HVD	7.3	4.9	2.4	6762	5052	1709
4	Kondagaon	4.3	HVD	4.8	2.9	1.9	3441	1247	2194
5	Balrampur	4.2	HVD	5.5	5.2	0.3	1718	1341	377
6	Dantewada	4.2	HVD	3.9	3.9	0.0	4053	4053	0
7	Jashpur	3.9	HVD	3.0	2.6	0.4	2672	1289	1383
8	Surajpur	3.8	HVD	1.3	1.1	0.1	937	893	44
9	Bastar	3.7	HVD	3.5	2.6	1.0	3492	1968	1524
10	Kanker	3.6	MVD	5.8	4.0	1.9	6841	3462	3379
11	Sarguja	3.4	MVD	5.6	3.0	2.6	7185	2427	4758
12	Gariyabandh	3.3	MVD	2.4	1.6	0.8	878	649	229
13	Kawardha	3.3	MVD	3.3	1.1	2.2	1890	161	1730
14	Koria	3.2	MVD	3.0	2.1	0.9	3001	2061	940
15	Mungeli	3.2	MVD	2.0	0.8	1.2	1215	25	1190
16	Korba	3.1	MVD	5.4	1.2	4.2	3928	872	3056
17	Mahasamund	3.0	MVD	2.7	0.8	1.9	2693	634	2059
18	Bemetara	2.9	MVD	1.5	1.2	0.3	933	575	358
19	Balodabazar	2.9	LVD	2.5	1.4	1.2	1583	1202	381
20	Raigarh	2.8	LVD	6.0	3.2	2.7	3148	686	2461
21	Rajnandgaon	2.7	LVD	8.5	5.2	3.3	5120	1327	3793
22	Balod	2.6	LVD	3.4	1.4	2.0	3882	841	3041
23	Janjgir	2.4	LVD	2.3	1.0	1.3	2590	937	1653
24	Dhamtari	2.1	LVD	9.0	4.7	4.3	12,849	2511	10,338
25	Bilaspur	1.7	LVD	11.6	1.5	10.1	15,000	1092	13,908
26	Durg	0.6	LVD	9.4	2.2	7.3	7428	1449	5978
27	Raipur	0.2	LVD	18.7	1.0	17.7	20,042	3136	16,906

Table 4. Correlation between the district vulnerability index and insurance scheme indicators (Pearson’s correlation coefficient with 95% confidence intervals).

	Vulnerability index
			95% CI
Availability indicators	Correlation coefficient	p- value	Lower limit	Upper limit
Enrolled population as proportion of census population	−0.077	0.702	−0.444	0.312
Enrolled HHs as proportion of census HHs	−0.133	0.508	−0.488	0.260
Number of empanelled hospitals/100,000 enrolled	−0.583	0.001*	−0.788	−0.260
Public empanelled hospitals/100,000 enrolled	0.414	0.032*	0.040	0.686
Private empanelled hospitals/100,000 enrolled	−0.750	< 0.001*	−0.879	−0.517
Number of claims/100,000 enrolled	−0.630	< 0.001*	−0.815	−0.328
Number of public claims/100,000 enrolled	0.197	0.324	−0.198	0.537
Number of private claims/100,000 enrolled	−0.760	< 0.001*	−0.884	−0.533

* Significant values at 0.05 level.

Figure 2. Chhattisgarh state map showing empanelled public and private hospitals per 100,000 enrolled across districts and vulnerability groups.

Table 5. Number of hospitals empanelled, number of claims and claim amount for the financial year 2015–16, disaggregated by public/private, according to vulnerability group.

VI Groups	Highest vulnerability districts (HVD)	Middle vulnerability districts (MVD)	Lowest vulnerability districts (LVD)	State total	Ratio between MVD and HVD	Ratio between LVD and HVD
Total number of empanelled hospitals (2016)	83	142	510	735
Empanelled hospitals per 100,000 enrolled population	3.4	3.7	8.2	5.9	1.1	2.4
Empanelled public hospitals per 100,000 enrolled population	2.8	1.8	2.2	2.2	0.6	0.8
Empanelled private hospitals per 100,000 enrolled population	0.6	1.9	6	3.7	3.2	10
Total number of claims in 2015–16	59,432	133,237	516,104	708,773
Total claims (nos) per 100,000 enrolled	2,399.7	3,480.3	8,341.8	5,673.9	1.5	3.5
Public claims (nos) per 100,000 enrolled	1,606.0	1,291.9	1,461.0	1,437.9	0.8	0.9
Private claims (nos) per 100,000 enrolled	793.7	2,188.4	6,880.9	4,235.9	2.8	8.7
Total claims amount (in INR million) in 2015–16	307	780	2,778	3,864.9
Total claims amount (in INR 100,000) per 100,000 enrolled	124.1	203.6	449.0	309.4	1.6	3.6
Public claims amount (in INR 100,000) per 100,000 enrolled	70.3	49.1	48.3	52.9	0.7	0.7
Private claims amount (in INR 100,000) per 100,000 enrolled	53.9	154.6	400.6	256.5	2.9	7.4

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