The impact of health insurance on hypertension care: a household fixed effects study in India.
Care cascade
Health insurance
Health policy
Hypertension
Unmet needs
Journal
BMC public health
ISSN: 1471-2458
Titre abrégé: BMC Public Health
Pays: England
ID NLM: 100968562
Informations de publication
Date de publication:
22 Aug 2024
22 Aug 2024
Historique:
received:
27
09
2023
accepted:
12
08
2024
medline:
23
8
2024
pubmed:
23
8
2024
entrez:
22
8
2024
Statut:
epublish
Résumé
Hypertension is highly prevalent in India, but the proportion of patients achieving blood pressure control remains low. Efforts have been made to expand health insurance coverage nationwide with the aim of improving overall healthcare access. It is critical to understand the role of health insurance coverage in improving hypertension care. We used secondary data from the nationally representative sample of adults aged 15-49 years from the 2015-2016 National Family Health Survey (NFHS) in India. We defined the hypertension care cascade as four successive steps of (1) screened, (2) diagnosed, (3) treated, and (4) controlled, and operationalized these variables using blood pressure measurements and self-reports. We employed household fixed effect models that conceptually matched people with and without insurance within the household, to estimate the impact of insurance coverage on the likelihood of reaching each care cascade step, while controlling for a wide range of additional individual-level variables. In all 130,151 included individuals with hypertension, 20.4% reported having health insurance. For the insured hypertensive population, 79.8% (95% Confidence Interval: 79.3%-80.3%) were screened, 49.6% (49.0%-50.2%) diagnosed, 14.3% (13.9%-14.7%) treated, and 7.9% (7.6%-8.2%) controlled, marginally higher than the percentages for the uninsured 79.8% (79.5%-80.0%), 48.2% (47.9%-48.6%), 13.3% (13.1%-13.5%), and 7.5% (7.4%-7.7%) for each cascade step, respectively. From the household fixed effects model, health insurance did not show significant impact on the hypertension care cascade, with the estimated relative risks of health insurance 0.97 (0.93-1.02), 0.97 (0.91-1.03), 0.95 (0.77-1.30), and 0.97 (0.65-1.10) for each cascade step, respectively. We further performed stratified analyses by sociodemographic and behavioral risk factors and a sensitivity analysis with district fixed effects, all of which yielded results that confirmed the robustness of our main findings. Health insurance did not show significant impact on improving hypertension care cascade among young and middle-aged adults with hypertension in India. Innovative strategies for overcoming practical barriers to healthcare services in addition to improving financial access are needed to address the large unmet need for hypertension care.
Identifiants
pubmed: 39175008
doi: 10.1186/s12889-024-19759-1
pii: 10.1186/s12889-024-19759-1
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2287Informations de copyright
© 2024. The Author(s).
Références
Roth GA, Johnson C, Abajobir A, Abd-Allah F, Abera SF, Abyu G, et al. Global, regional, and national burden of cardiovascular diseases for 10 causes, 1990 to 2015. J Am Coll Cardiol. 2017;70(1):1–25.
pubmed: 28527533
pmcid: 5491406
doi: 10.1016/j.jacc.2017.04.052
Prabhakaran D, Jeemon P, Roy A. Cardiovascular diseases in India: current epidemiology and future directions. Circulation. 2016;133(16):1605–20.
pubmed: 27142605
doi: 10.1161/CIRCULATIONAHA.114.008729
Gupta R, Xavier D. Hypertension: the most important non communicable disease risk factor in India. Indian Heart J. 2018;70(4):565–72.
pubmed: 30170654
pmcid: 6116711
doi: 10.1016/j.ihj.2018.02.003
Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Global burden of hypertension: analysis of worldwide data. Lancet. 2005;365(9455):217–23.
pubmed: 15652604
doi: 10.1016/S0140-6736(05)17741-1
Gheorghe A, Griffiths U, Murphy A, Legido-Quigley H, Lamptey P, Perel P. The economic burden of cardiovascular disease and hypertension in low- and middle-income countries: a systematic review. BMC Public Health. 2018;18(1):975.
pubmed: 30081871
pmcid: 6090747
doi: 10.1186/s12889-018-5806-x
Prenissl J, Manne-Goehler J, Jaacks LM, Prabhakaran D, Awasthi A, Bischops AC, et al. Hypertension screening, awareness, treatment, and control in India: a nationally representative cross-sectional study among individuals aged 15 to 49 years. PLoS Med. 2019;16(5):e1002801.
pubmed: 31050680
pmcid: 6499417
doi: 10.1371/journal.pmed.1002801
Geldsetzer P, Manne-Goehler J, Marcus ME, Ebert C, Zhumadilov Z, Wesseh CS, et al. The state of hypertension care in 44 low-income and middle-income countries: a cross-sectional study of nationally representative individual-level data from 1·1 million adults. Lancet. 2019;394(10199):652–62.
pubmed: 31327566
doi: 10.1016/S0140-6736(19)30955-9
Mohanty SK, Pedgaonkar SP, Upadhyay AK, Kämpfen F, Shekhar P, Mishra RS, et al. Awareness, treatment, and control of hypertension in adults aged 45 years and over and their spouses in India: a nationally representative cross-sectional study. PLoS Med. 2021;18(8):e1003740.
pubmed: 34428221
pmcid: 8425529
doi: 10.1371/journal.pmed.1003740
He J, Muntner P, Chen J, Roccella EJ, Streiffer RH, Whelton PK. Factors associated with hypertension control in the general population of the United States. Arch Intern Med. 2002;162(9):1051–8.
pubmed: 11996617
doi: 10.1001/archinte.162.9.1051
Smolderen KG, Spertus JA, Nallamothu BK, Krumholz HM, Tang F, Ross JS, et al. Health care insurance, financial concerns in accessing care, and delays to hospital presentation in acute myocardial infarction. JAMA. 2010;303(14):1392–400.
pubmed: 20388895
pmcid: 3020978
doi: 10.1001/jama.2010.409
Duru OK, Vargas RB, Kermah D, Pan D, Norris KC. Health insurance status and hypertension monitoring and control in the United States. Am J Hypertens. 2007;20(4):348–53.
pubmed: 17386339
doi: 10.1016/j.amjhyper.2006.11.007
DeVoe JE, Fryer GE, Phillips R, Green L. Receipt of preventive care among adults: insurance status and usual source of care. Am J Public Health. 2003;93(5):786–91.
pubmed: 12721145
pmcid: 1447840
doi: 10.2105/AJPH.93.5.786
Yoon PW, Gillespie CD, George MG, Wall HK. Control of hypertension among adults–national health and nutrition examination survey, United States, 2005–2008. MMWR Suppl. 2012;61(2):19–25.
pubmed: 22695459
H A, Bb G, K F, M M, N H, A L, et al. Role of health insurance and neighborhood-level social deprivation on hypertension control following the affordable care act health insurance opportunities. Soc Sci Med. 2020;265:113439.
Suh HS, Kang HY, Kim J, Shin E. Effect of health insurance type on health care utilization in patients with hypertension: a national health insurance database study in Korea. BMC Health Serv Res. 2014;14(1):570.
pubmed: 25412904
pmcid: 4243280
doi: 10.1186/s12913-014-0570-9
Berry KM, Parker WA, Mchiza ZJ, Sewpaul R, Labadarios D, Rosen S, et al. Quantifying unmet need for hypertension care in South Africa through a care cascade: evidence from the SANHANES, 2011–2012. BMJ Glob Health. 2017;2(3):e000348.
pubmed: 29082013
pmcid: 5656122
doi: 10.1136/bmjgh-2017-000348
Colombe S, Machemba R, Mtenga B, Lutonja P, Safari W, Beard J, et al. Cascade of care for HIV-seroconverters in rural Tanzania: a longitudinal study. AIDS Care. 2020;32(5):666–71.
pubmed: 31288545
doi: 10.1080/09540121.2019.1640842
Polanco-Pasaje JE, Rodríguez-Márquez I, Tello-Hoyos KY, Torres-Pereda P, Guzmán-Salazar BL, Pérez F. Tuberculosis care cascade for the indigenous population in Colombia: an operational research study. Rev Panam Salud Publica. 2021;23(45):1.
doi: 10.26633/RPSP.2021.20
Subbaraman R, Jhaveri T, Nathavitharana RR. Closing gaps in the tuberculosis care cascade: an action-oriented research agenda. J Clin Tuberc Other Mycobact Dis. 2020;19:100144.
pubmed: 32072022
pmcid: 7015982
doi: 10.1016/j.jctube.2020.100144
Kazemian P, Shebl FM, McCann N, Walensky RP, Wexler DJ. Evaluation of the cascade of diabetes care in the United States, 2005–2016. JAMA Intern Med. 2019;179(10):1376–85.
pubmed: 31403657
pmcid: 6692836
doi: 10.1001/jamainternmed.2019.2396
McMahon BJ, Townshend-Bulson L, Homan C, Gounder P, Barbour Y, Hewitt A, et al. Cascade of care for alaska native people with chronic hepatitis C virus infection: statewide program with high linkage to care. Clin Infect Dis. 2020;70(9):2005–7.
pubmed: 31504307
doi: 10.1093/cid/ciz832
Rogers ME, Balistreri WF. Cascade of care for children and adolescents with chronic hepatitis C. World J Gastroenterol. 2021;27(12):1117–31.
pubmed: 33828389
pmcid: 8006101
doi: 10.3748/wjg.v27.i12.1117
Ali KM, Bullard K, Gregg E, Rio C. A Cascade of Care for Diabetes in the United States: visualizing the gaps. Ann Intern Med. 2014;161(10):681–9.
pubmed: 25402511
doi: 10.7326/M14-0019
Deeks SG, Lewin SR, Havlir DV. The end of AIDS: HIV infection as a chronic disease. Lancet. 2013;382(9903):1525–33.
pubmed: 24152939
pmcid: 4058441
doi: 10.1016/S0140-6736(13)61809-7
Wozniak G, Khan T, Gillespie C, Sifuentes L, Hasan O, Ritchey M, et al. Hypertension control cascade: a framework to improve hypertension awareness, treatment, and control. J Clin Hypert. 2016;18(3):232–9.
doi: 10.1111/jch.12654
Foti K, Wang D, Appel LJ, Selvin E. Hypertension awareness, treatment, and control in US adults: trends in the hypertension control cascade by population subgroup (National Health and Nutrition Examination Survey, 1999–2016). Am J Epidemiol. 2019;188(12):2165–74.
pubmed: 31504121
pmcid: 7212399
doi: 10.1093/aje/kwz177
Lee J, Wilkens J, Meijer E, Sekher TV, Bloom DE, Hu P. Hypertension awareness, treatment, and control and their association with healthcare access in the middle-aged and older Indian population: a nationwide cohort study. PLoS Med. 2022;19(1):e1003855.
pubmed: 34982770
pmcid: 8726460
doi: 10.1371/journal.pmed.1003855
Osetinsky B, Mhalu G, Mtenga S, Tediosi F. Care cascades for hypertension and diabetes: cross-sectional evaluation of rural districts in Tanzania. PLoS Med. 2022;19(12):e1004140.
pubmed: 36469527
pmcid: 9762578
doi: 10.1371/journal.pmed.1004140
Anekwe TD, Newell ML, Tanser F, Pillay D, Bärnighausen T. The causal effect of childhood measles vaccination on educational attainment: a mother fixed-effects study in rural South Africa. Vaccine. 2015;33(38):5020–6.
pubmed: 25936663
pmcid: 4570928
doi: 10.1016/j.vaccine.2015.04.072
Bärnighausen T, Oldenburg C, Tugwell P, Bommer C, Ebert C, Barreto M, et al. Quasi-experimental study designs series—paper 7: assessing the assumptions. J Clin Epidemiol. 2017;89:53–66.
pubmed: 28365306
doi: 10.1016/j.jclinepi.2017.02.017
Oakes JM, Kaufman JS, editors. Methods in social epidemiology. 2 eds. San Francisco : Jossey-Bass, A Wiley Brand; 2017. p. 568 .
Fujiwara T, Kawachi I. Is education causally related to better health? A twin fixed-effect study in the USA. Int J Epidemiol. 2009;38(5):1310–22.
pubmed: 19528192
doi: 10.1093/ije/dyp226
International Institute for Population Sciences (IIPS) and ICF. National Family Health Survey (NFHS-4), 2015–16: India. Mumbai: IIPS; 2017.
Available Datasets. The Demographic and Health Surveys (DHS) Program. Available from: https://www.dhsprogram.com/data/available-datasets.cfm .
Lahariya C. Ayushman Bharat” program and universal health coverage in India. Indian Pediatr. 2018;55(6):495–506.
pubmed: 29978817
doi: 10.1007/s13312-018-1341-1
Sriee GVV, Maiya GR. Coverage, utilization, and impact of Ayushman Bharat scheme among the rural field practice area of Saveetha medical college and hospital. Chennai J Family Med Prim Care. 2021;10(3):1171–6.
doi: 10.4103/jfmpc.jfmpc_1789_20
Ved RR, Gupta G, Singh S. India’s health and wellness centres: realizing universal health coverage through comprehensive primary health care. WHO South East Asia J Public Health. 2019;8(1):18–20.
pubmed: 30950425
doi: 10.4103/2224-3151.255344
Association of Physicians of India. ndian guidelines on hypertension (I.G.H.) - III. 2013. J Assoc Physicians India. J Assoc Physicians India. 2013;61(2 Suppl):6–36.
Cdc. High blood pressure during pregnancy. 2021.
Andrade C. Understanding relative risk, odds ratio, and related terms: as simple as it can get: (Clinical and Practical Psychopharmacology). J Clin Psychiatry. 2015;76(07):e857–61.
pubmed: 26231012
doi: 10.4088/JCP.15f10150
Zou G. A modified poisson regression approach to prospective studies with binary data. Am J Epidemiol. 2004;159(7):702–6.
pubmed: 15033648
doi: 10.1093/aje/kwh090
Office of the Registrar General & Census Commissioner, India. Census of India 2011. New Delhi: Ministry of Home Affairs, Government of India; 2011. Available from: http://censusindia.gov.in .
Prinja S, Bahuguna P, Gupta I, Chowdhury S, Trivedi M. Role of insurance in determining utilization of healthcare and financial risk protection in India. . Buttigieg SC, editor. PLoS One. 2019;14(2):e0211793.
pubmed: 30721253
pmcid: 6363222
doi: 10.1371/journal.pone.0211793
Maurya D, Ramesh M. Program design, implementation and performance: the case of social health insurance in India. HEPL. 2019;14(4):487–508.
doi: 10.1017/S1744133118000257
Ahlin T, Nichter M, Pillai G. Health insurance in India: what do we know and why is ethnographic research needed. Anthropol Med. 2016;23(1):102–24.
pubmed: 26828125
doi: 10.1080/13648470.2015.1135787
Dang A, Dang D, Vallish BN. Importance of evidence-based health insurance reimbursement and health technology assessment for achieving universal health coverage and improved access to health in India. Value Health Reg Issues. 2021;1(24):24–30.
doi: 10.1016/j.vhri.2020.04.007
Kusuma YS, Pal M, Babu BV. Health insurance: awareness, utilization, and its determinants among the urban poor in Delhi. India J Epidemiol Glob Health. 2018;8(1–2):69–76.
pubmed: 30859791
doi: 10.2991/j.jegh.2018.09.004
Liao Y, Gilmour S, Shibuya K. Health insurance coverage and hypertension control in China: results from the China health and nutrition survey. PLoS One. 2016;11(3):e0152091.
pubmed: 27002634
pmcid: 4803201
doi: 10.1371/journal.pone.0152091
Khetrapal S, Acharya A, Mills A. Assessment of the public-private-partnerships model of a national health insurance scheme in India. Soc Sci Med. 2019;1(243):112634.
doi: 10.1016/j.socscimed.2019.112634
Khera N, Zeliadt SB, Lee SJ. Economics of hematopoietic cell transplantation. Blood. 2012;120(8):1545–51.
pubmed: 22700725
doi: 10.1182/blood-2012-05-426783
Levesque JF, Harris MF, Russell G. Patient-centred access to health care: conceptualising access at the interface of health systems and populations. Int J Equity Health. 2013;12(1):18.
pubmed: 23496984
pmcid: 3610159
doi: 10.1186/1475-9276-12-18
Das H, Moran AE, Pathni AK, Sharma B, Kunwar A, Deo S. Cost-effectiveness of improved hypertension management in India through increased treatment coverage and adherence: a mathematical modeling study. Glob Heart. 2021;16(1):37.
pubmed: 34040950
pmcid: 8121007
doi: 10.5334/gh.952
McCrindle BW. Assessment and management of hypertension in children and adolescents. Nat Rev Cardiol. 2010;7(3):155–63.
pubmed: 20065950
doi: 10.1038/nrcardio.2009.231
Rani R, Kannaujiya AK, Talukdar P, Sikarwar A. Gender and rural-urban differences in hypertension among youth in India: Insights from a large scale survey, 2015-16. J Biosoc Sci. 2022;55(3):523–37. https://doi.org/10.1017/s0021932022000141 .
Vimala A, Ranji SA, Jyosna MT, Chandran V, Mathews SR, Pappachan JM. The prevalence, risk factors and awareness of hypertension in an urban population of Kerala (South India). Saudi J Kidney Dis Transpl. 2009;20(4):685–9.
pubmed: 19587522
Williams CL, Hayman LL, Daniels SR, Robinson TN, Steinberger J, Paridon S, et al. Cardiovascular health in childhood: a statement for health professionals from the committee on Atherosclerosis, Hypertension, and Obesity in the Young (AHOY) of the council on cardiovascular disease in the young American Heart Association Circulation. Circulation. 2002;106(1):143–60.
pubmed: 12093785
doi: 10.1161/01.CIR.0000019555.61092.9E
Kirk S, Zeller M, Claytor R, Santangelo M, Khoury PR, Daniels SR. The relationship of health outcomes to improvement in bmi in children and adolescents. Obes Res. 2005;13(5):876–82.
pubmed: 15919841
doi: 10.1038/oby.2005.101
Atun R, Aydın S, Chakraborty S, Sümer S, Aran M, Gürol I, et al. Universal health coverage in Turkey: enhancement of equity. Lancet. 2013;382(9886):65–99.
pubmed: 23810020
doi: 10.1016/S0140-6736(13)61051-X
Mancheno C, Asch DA, Klinger EV, Goldshear JL, Mitra N, Buttenheim AM, et al. Effect of posting on social media on systolic blood pressure and management of hypertension: a randomized controlled trial. J Am Heart Assoc. 2021;10(19):e020596.
pubmed: 34558301
pmcid: 8649152
doi: 10.1161/JAHA.120.020596
Chen S, Sudharsanan N, Huang F, Liu Y, Geldsetzer P, Bärnighausen T. Impact of community based screening for hypertension on blood pressure after two years: regression discontinuity analysis in a national cohort of older adults in China. BMJ. 2019;366:l4064.
pubmed: 31296584
pmcid: 6619453
doi: 10.1136/bmj.l4064
Damianaki A, Theiler K, Beaney T, Wang W, Burnier M, Wuerzner G. High blood pressure screening in pharmacies during May Measurement Month campaigns in Switzerland. Blood Press. 2022;31(1):129–38.
pubmed: 35699311
doi: 10.1080/08037051.2022.2086531
Kotwani P, Kwarisiima D, Clark TD, Kabami J, Geng EH, Jain V, et al. Epidemiology and awareness of hypertension in a rural Ugandan community: a cross-sectional study. BMC Public Health. 2013;13(1):1151.
pubmed: 24321133
pmcid: 3890617
doi: 10.1186/1471-2458-13-1151
Wamuti B, Owuor M, Magambo C, Ndegwa M, Sambai B, Temu TM, et al. ‘My people perish for lack of knowledge’: barriers and facilitators to integrated HIV and hypertension screening at the Kenyatta National Hospital, Nairobi, Kenya. Open Heart. 2023;10(1):e002195.
pubmed: 36707130
pmcid: 9884934
doi: 10.1136/openhrt-2022-002195
Adler AJ, Laar A, Prieto-Merino D, Der RMM, Mangortey D, Dirks R, et al. Can a nurse-led community-based model of hypertension care improve hypertension control in Ghana? Results from the ComHIP cohort study. BMJ Open. 2019;9(4):e026799.
pubmed: 30944139
pmcid: 6500340
doi: 10.1136/bmjopen-2018-026799
Jafar TH, Gandhi M, De Silva HA, Jehan I, Naheed A, Finkelstein EA, et al. A community-based intervention for managing hypertension in rural South Asia. N Engl J Med. 2020;382(8):717–26.
pubmed: 32074419
doi: 10.1056/NEJMoa1911965
Redmond N, Baer HJ, Hicks LS. Health behaviors and racial disparity in blood pressure control in the national health and nutrition examination survey. Hypertension. 2011;57(3):383–9.
pubmed: 21300667
doi: 10.1161/HYPERTENSIONAHA.110.161950
Jerant A, Fiscella K, Tancredi DJ, Franks P. Health insurance is associated with preventive care but not personal health behaviors. J Am Board Fam Med. 2013;26(6):759–67.
pubmed: 24204073
doi: 10.3122/jabfm.2013.06.130054
Lee J. Effects of health insurance coverage on risky behaviors. Health Econ. 2018;27(4):762–77.
pubmed: 29341413
doi: 10.1002/hec.3634
Miraldo M, Propper C, Williams RI. The impact of publicly subsidised health insurance on access, behavioural risk factors and disease management. Soc Sci Med. 2018;217:135–51.
pubmed: 30321836
doi: 10.1016/j.socscimed.2018.09.028
Zhao G, Hsia J, Town M. Health-related behaviors and health insurance status among US adults: findings from the 2017 behavioral risk factor surveillance system. Prev Med. 2021;148:106520.
pubmed: 33744329
pmcid: 10961720
doi: 10.1016/j.ypmed.2021.106520
Hogan DR, Stevens GA, Hosseinpoor AR, Boerma T. Monitoring universal health coverage within the sustainable development goals: development and baseline data for an index of essential health services. Lancet Glob Health. 2018;6(2):e152–68.
pubmed: 29248365
doi: 10.1016/S2214-109X(17)30472-2