The controversial Affordable Care Act of 2010 seeks to extend health insurance to 30 million people in an affluent country where 80 percent of the population already has health insurance. By comparison, India introduced a health insurance program in 2008 designed to cover 300 million people—ten times the number impacted by the Affordable Care Act—in a country where only five percent of the population has health insurance.
“The United States is not the only country wrestling with health care reform,” says Anup Malani, a professor of law and medicine at the University of Chicago’s Law School and Medical School. “We could all be learning from each other, but in order to do so we must be able to measure the value of health insurance and the things it provides—not only access to health care but also peace of mind, financial freedom and protection from the shock of large health care costs.”
The Indian health care initiative, called Rashtriya Swasthya Bima Yojna (RSBY), is aimed at providing nearly free hospital services to Indians in the lowest quarter of the income scale. Now that the program is about half implemented, the Indian government is evaluating the possibility of extending coverage to residents in the middle half of the income scale and/or expanding coverage to include physician services, diagnostic tests and pharmaceuticals.
Whether to do so and, if so, how are huge questions. To help answer them, Malani, as principal investigator, is conducting several interdisciplinary studies involving roughly 60,000 Indians spread over hundreds of villages in the state of Karnataka. Preliminary results are expected by mid 2014.
“Given RSBY’s young age, the lack of data on utilization patterns and the absence of any experimental evaluation studies, policymakers should exercise caution before judging the merits of the program,” Malani says. “We are conducting rigorous research based on randomized, impact evaluations in order to ascertain the program’s true benefits, much of which are currently masked by the methodological problems in previously conducted observational studies.”
The new research is aimed at determining not only what impact the health insurance program has had, thus far, but also why it has had this impact. Does health insurance improve health? Or does it mainly reduce the financial burden of paying for health care? Are there gender disparities in who benefits? “Our research will help the government improve the program rather than just expand it,” Malani says.
New international health policy center
Malani hopes this research will spawn a center to study health care economics and policies internationally, as well as to monitor diseases. Located at the University of Chicago, the center would include scholars from around the country and world, in particular those engaged in research in host countries, including India. And in Mexico, the center could study the effectiveness of Seguro Popular, a government health insurance plan for the poor launched in 2003.
Arete has helped Malani and his coworkers define the center’s mission and identify key foundations that might be interested in supporting the work.
“Rather than telling us what we should do, Arete staff members have spent a lot of time listening to what our research is all about,” Malani says. “As a result, they know our agenda and objectives, so they can do a better job identifying the best potential funding matches for us.”
As Malani applies to foundations for funds, he hopes the center will be operational by the fall of 2014. “The center will go beyond the current studies in India, but the researchers involved in these studies will form the core set of faculty for the center, as well as provide bridges to other experts,” says Malani, who has a PhD in economics and a law degree, both from the University of Chicago. “We’ll take an interdisciplinary approach, engaging, for example, anthropologists and psychologists, and we’ll aim for having a practical impact in the real world.”
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