Objectives: The National Health Insurance Scheme of India, i.e., Rashtriya Swasthya Bima Yojana, and the Odisha State health insurance scheme, i.e., Biju Krushak Kalayan Yojanaaim to provide financial protection to target population against catastrophic health expenditure by reducing out-of-pocket spending and improve access to quality healthcare. The study estimates healthcare expenditure of beneficiaries, the extent of use of the scheme and to point out obstacles that the beneficiaries face.
Methodology: The study was based on both secondary and primary data. Multi-stage random sampling method is used to select 200 beneficiaries of both the scheme. Data were collected through direct personal interviews by using structured schedules. Descriptive statistics are used to substantiate the objectives. Qualitative data were also analysed briefly to supplement quantitative analysis.
Results: The average amount of expenditure on Medicine, Diagnostic and Food and accommodation incurred by beneficiaries for their treatment were quiet high. The overall spending on medicine in proportion of total healthcare payment was 60.01%.47.5% beneficiaries spend from own pocket for their treatment. Only 5.7% beneficiaries fully access the facilities of the scheme. The average claimed amount and received amount was only `6246 and `3632.70 respectively. Only 58.15% of the claimed amount was only realized. The obstacles faced by the beneficiaries in the reimbursement of the claimed amount are bureaucratic official procedures, mismatch of the fingerprint of beneficiaries, failure of networking of installed software, more amounts of money deducted than released amount and exploitation involved in the delivery of facilities.
Conclusions: This paper contributes to the current debate on financial protection provided by the health insurance scheme which is burning issue in the healthcare sector. The finding of the study may help the policymaker to create awareness among insured, the behaviour of healthcare providers may be turned friendly, immediate attention may be provided by help desk counters to the beneficiaries, the sum assured amount may be increased and the detailed receipt of hospital expenditure may be supplied to the insured at the time of discharge.