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Effectiveness of health insurance in the unorganized sector of Punjab(An Empirical Study).
1. 1
Effectiveness on the Health Insurance Schemes amongst
Unorganized sector in Punjab (An Empirical study).
Presented by
(Navneet kaur)
Reg. No.- 41600133
Under the supervision of
(Dr. Rupesh Roshan Singh)
Associate Professor
A Research Proposal of the Ph.D. thesis
on
3. Abstract
The economic and social development of a country depends on the quality of its
human resources, in turn, depends on the quality of education and health services.
But, in India, Public health facilities suffer from poor management, low service
quality, and weak finances. On the other hand, private health facilities are expensive,
At the same time, health insurance companies have sown interest in offering health
insurance products to unorganized sector workers in Punjab. For the findings and the
results the researcher will gathered and analyzed empirical data through structured
questionnaire approx. 576 respondents of unorganized sector of Punjab. “Multi-stage
stratified sampling” will be used for short listing the respondents responses through
the detailed study expected results The outcome of the study will help to know the
reality of health insurance schemes. So, it would be easy to making appropriate health
insurance schemes for the unorganized sector workers by which the health status and
productivity of the nation can be further improved.
4. Introduction
What is health insurance.
In today’s dynamic world, health is playing a vital role. Health insurance is an
insurance that covers the whole or part of the risk of a person incurring medical
expenses, spreading the risk over numerous persons.
Section 2 (6C) of Insurance Act, 1938 defines Health Insurance Business as ,under:
“health insurance business” means the effecting of contracts which provide for.
Sickness benefits or medical, surgical or hospital expense benefits, whether in-patient
or out-patient travel cover and personal accident cover”.
But, the workers in the unorganized sector are completely ignoring their health due to
lack of awareness, lack of government support, illiteracy, paying expenses for medical
facilities out-of-pocket and so on. The government is framing many plans and policies
to overcome these barriers (Fang et al., 2019).
5. Unorganized sector workers
The term ‘unorganized sector’ is used commonly in all official records and analysis.
Keith Hart is the first person to introduce the term ‘Unorganized sector’ and
distinguished organized and unorganized income opportunities on the basis of
whether the activity entailed wage or self employment (Hart, 1973). Unorganized
workers can be categorized broadly under the following four heads namely
(Economic Review 2010, Government of Punjab),.
1. In terms of occupation
Small and marginal farmers, landless agricultural labourers, fishermen, leather
workers, weavers, artisans, those engaged in animal husbandry, beedi rolling,
labelling and packing, building and construction, brick kilns and stone quarries,
sawmills, oil mills, etc come in this category.
6. 2. In terms of nature of employment
Agricultural labourers, bonded labourers, migrant workers, contract and casual
labourers come under this category.
3.In terms of specially distressed categories
Toddy tappers, scavengers, carriers of head loads, drivers of animal driven
vehicles, loaders and un-loaders belong to this category.
4. In terms of service categories
Midwives, domestic workers, fishermen and women, barbers, vegetable and
fruit vendors, news paper vendors, etc come under this category.
8. S. NO. State ESIS CGHS
Expenditure
on RSBY &
other state
schemes
Total Exp.
On Health
Insurance
Exp. On
tertiary
care
Total
Health
Expenditure
1 Andhra Pradesh 16418 6611 120000 143029 63102 385439
2 Assam 1742 128 86 1956 69852 210296
3 Bihar 1511 1311 5204 8026 55471 215414
4 Chhattisgarh 689 0 3052 3741 6753 213262
5 Delhi 49036 59745 278 180789 64145 210488
6 Gujarat 11182 893 4007 16082 47633 214217
7 Goa 1378 0 24 1402 23697 210234
8 Haryana 6873 0 4753 11626 18981 214963
9
Himachal
Pradesh
1290 0 509 1799 23697 210719
10 Jharkhand 1504 347 2146 3997 18981 212356
11 Karnataka 10691 7764 5500 23955 95374 281155
12 Kerala 9817 812 5984 16613 75068 216194
13 Madhya Pradesh 4696 1647 0 6343 14933 210210
14 Maharashtra 22904 4691 7144 34739 96340 217354
15 Orissa 2983 342 0 3325 33806 210210
16 Punjab 10569 0 868 11437 44307 211078
17 Rajasthan 7566 1571 - 9137 86,849 210210
18 Tamil Nadu 16910 3165 52547 72,622 87,596 317562
19 Uttar Pradesh 7683 8266 10045 25994 1,20,153 812923
20 Uttarakhand 521 347 315 1183 16,381 803193
21 West Bengal 14105 4518 4097 22720 1,51,879 806975
22 Others 14292 61626 299 76217 - 268681
- - 7,00,000 7,00,000 - -
2,14,359 1,60,015 9,26,861 13,01,235 12,12,681 68,63,136
2,144 1600 9,269 13,013 12,127 68,631
PHI(2016-17)
Total (in lakhs)
Total(incrores)
Table 2. Contributions of health insurance schemes and tertiary care spending In lakhs of Rs.)
9. Problems of unorganized sector workers in Punjab:
Very low wages is the main problem for unorganized workers.
Maximum workers do not have any perfect living areas near to their work place.
They do not have any knowledge about work hazardous and occupational safety.
Overtime, paid holiday or sick leave are not provided to them.
They do not have idea on Trade Union/labour Union.
High level job insecurity is a common phenomenon unorganized sector.
Women and child workers are vulnerable and draw very low wages.
Maximum workers are leaving in a very deplorable condition.
Lack of quality employment due to fraudulent acting of contractor.
Loss of employment due to silly reason is a natural incident.
Numbers of harassment issues at work place for working women.
Susceptible to diseases.
Bonded labour.
10. Growth of Health insurance in India.
(2011-2018)
Source: https://www.statista.com/statistics/1080112/india-health-insurance-
penetration/
11. Description on health insurance schemes.
These schemes intend to provide health insurance security to the weaker and
deprived sections of the society.
Health Insurance Schemes for the unorganised workers in Punjab Issued by the “central government.”
Table 1.
Name of the scheme Year of Implementation
Central Government Health Schemes New Delhi, 1954
Employees State Insurance Scheme Employees state insurance act,1948
Rashtrya Swasthya Bima Yojana 2008 (for the below poverty line)
Aam Aadmi BimaYojana 2007
Universal health insurance scheme 2007
Ayushman Bharat Sarbat Sehat BimaYojana 2018
12. National Health Insurance Schemes for the unorganized sector workers;
National Health Insurance Schemes are the health insurance programs initiated by the National
Government(Prinja et al., 2019). To make health insurance accessible to the poor and destitute,
our government has launched some health insurance schemes such as(Khetrapal et al., 2019)
Rashtriya Swasthya Bima Yojana, Central Government Health Scheme, Employment State
Insurance Scheme, Universal Health Insurance Scheme, Aam Aadmi Bima Yojana and
Janashree Bima Yojajna among others.Healthy citizens are a priority for every government.
Let’s check out the benefits offered by these schemes in detail-
Rashtriya Swasthiya Bima Yojana(RSBY): -
Ministry of labour & Employment, Government of India launched this National Health
Insurance Scheme for Families who are below the poverty line. The scheme provides hospital
treatment for people who are below poverty line access to public and private hospitals for
Rs.30,000 per year for 5 members in the family(Yuen et al., 2020). This scheme was launched
in 2007.
13. Employment State Insurance Scheme(ESIS);
This is a government scheme that ensures a cover customized according to the needs
of the workers and policyholders covered under this health insurance policy.
Policyholders and their dependents covered under the ESIS policy not only avail full
medical cover but are also entitled to additional cover in case of any emergencies
owing to permanent or total disability(Binnendijk et al., 2013).
Central Government Health Scheme(CGHS);
This scheme is nothing short of a boon to all those employees employed with the
Central Government. The scheme applies to pensioners and their dependents
too(Bahuguna et al., 2018).
Aam Aadmi Bima Yojana(AABY);
The scheme has introduced the concept of health insurance in 2007 to the landless
and rural Indian population, the AABY scheme covers people aged between 10 and
59 years.
14. Universal Health Insurance Scheme (UHIS);
This scheme came in the wake of rising hospitalization expenses and reports of poor
families’ inability to afford medical treatment at hospitals or medical treatment
centers.
Ayushman Bharat
This scheme introduced under the National Health Protection Mission aims to
provide coverage to more than 10 crore vulnerable families by offering coverage up
to Rs. 5 lakhs to every policyholder and dependents in the event of primary,
secondary or tertiary hospitalization.
15. Review of Literature
Health Insurance
Author/Title Name/Vol./Issue No. Findings/Result
“Impact of Publicly Financed
Health Insurance Schemes on
Healthcare Utilization and
Financial Risk Protection in
India: A Systematic Review.”
(2017)
The impact of publicly financed health insurance schemes on health
service utilization, out-of-pocket (OOP) expenditure, financial risk
protection and health status.
Role of insurance in determining
utilization of healthcare and
financial risk protection in India,
Prinja.et.al (2019)
The relationship of HI and RSBY on out-of-pocket (OOP) expenditures
and financial risk protection (FRP). The association of health insurance
(HI) schemes in general, and RSBY (National Health Insurance
Scheme).
“The state of enrolment on the
National Health Insurance
Scheme in rural Ghana after
eight years of implementation
Anthony”
Kwarteng, Anthony
Akazili, (2019).
Despite the introduction of policy exemptions as an equity measure, the
poorest of the poor were rarely identified for exemption. The
government must urgently resource the Department of Social Welfare
to identify the poor for NHIS (National Health Insurance Schemes)
enrolment.
16. Transforming Health Care In
India: Ayushman Bharat-
national Health Protection
Mission Tabish, S A (2018)
Inequalities and health-related expenses resulting in impoverishment
further marginalises the poor, underprivileged and outreach. The
government of India has come up with a highly ambitious initiative
Ayushman Bharat – National Health Protection Mission (AB-NHPM) as
a shift from traditional health planning approaches towards a
comprehensive healthcare vision.
AWARENESS,
CHALLENGES AND
OPPORTUNITIES OF
HEALTH INSURANCE IN
INDIA Shivany M
Vinoth(2017)
This paper focuses primarily on the issues and opportunities for India's
health insurance sector and secondarily on its genesis and growth. This
will clearly lead to high out-of-pocket expenditure and for the rural
population it becomes unaffordable.
Health Insurance
Review of Literature
17. Review of Literature
Unorganized sector workers
Author/Title
Name/Vol./Issue No.
Findings/Result
“Sub-national health
accounts: Experience from
Punjab State in India”
Pankaj Bahuguna1,
Prinja(2018)
Public health spending in India has been traditionally one of the lowest
globally. Punjab is one of the states with highest proportion of out-of-pocket
expenditures for healthcare in India. This study to produce the sub-national
health accounts (SNHA) for Pun- jab state in India.
“Occupational Health
problems in Informal
Sector in India need
immediate attention”,
Kishore(2017)
Unorganized workers do not have social security benefits which workers in the
formal sector enjoy from their employers and government. Due to a lack of
regulations governing occupational safety and standards in the unorganized
sector, the occurrence of occupational diseases in common among these
workers.
“Labourers of Unorganised
sectors and their
Problems” Prof. (Dr.)
Subhasish
Chatterjee(2016)
It is crystal clear that unorganized labours are living their life below the
minimum standards level. Without a doubt, many informal workers are not in a
position to meet their daily requirement. Maximum numbers of women worker
are consistent victims of low wages when contrasted with men. There are
number of legislations for the security of the labour force but those laws are
routinely executed in organized sectors yet in actuality, it is not used
methodically in unorganized sectors.
18. Review of Literature
Unorganized sector workers in Punjab
Author/Title Name/Vol./Issue
No.
Findings/Result
“Assessment of the public-
private-partnerships model
of a national health
insurance scheme in India”
Sonalini Khetrapal
(2019)
Findings show regulatory weaknesses, and contractual breaches. Enrolment
rates were low in both districts and more so for Patiala and there was limited
access to services. RSBY helped improve accessibility and gave some degree
of financial protection to patients. It also actively engaged with existing
resources in the Indian health care and insurance markets.
“Health Care for the Poor
in India with Special
Reference to Punjab State”
B. S. Ghuman1 Akshat
Mehta(2017)
At present, there are three health-care policy initiatives for the poor: (i)
exemption from the user fee in government hospitals; (ii) free treatment in
private super-specialty hospitals (within a defined proportion of total
patients); and (iii) health insurance. This paper examines health care for the
poor in India, particularly in the state of Punjab.
“Awareness and
Willingness to Pay for
Health Insurance: A Study
of Darjeeling District
“Darjeeling, India(2015)
This study examines the respondents who are aware or not aware about
health insurance as well as various sources of awareness; secondly, those
who are aware have subscribed for it or not; thirdly, those who have not
subscribed what are the reasons behind the same; and lastly are they willing
to join and pay for it? If yes then what would be the possible amount?
19. Objectives
1. To identify the socio-economic determinants among the workers of
unorganized sector, Punjab.
2. To study the various health insurance schemes for unorganized sector workers
in Punjab.
3. To analyze the willingness of unorganized sector workers for making the
decision of health insurance schemes.
4. To formulate the recommendations for unorganized sector workers to improve
awareness for health insurance schemes.
20. Sr. No. Objectives Methodology
1. To identify the socio-economic determinants among the
workers of unorganized sector, Punjab.
Data will be collected through questionnaire
and data will be analyzed by Logistic
regression analysis/ SPSS
2. To study the various health insurance schemes for
unorganized sector workers in Punjab.
Data will be collected through questionnaire
and data will be analyzed comparative study of
workers among various sectors, the researcher
used averages, frequency, graphical method
and Chi- square test by SPSS
3. To analyze the willingness of unorganized sector
workers for making the decision of health insurance
schemes.
Data will be collected through Questionnaire.
Concept of health insurance and Perception
will be measured with different variables by
using Five- point Likert Scale
4. To formulate the recommendations for unorganized
sector workers to improve awareness for health
insurance schemes.
Data will be analyzed by Structural Equation
Modelling, Exploratory and Confirmatory
Factor Analysis through SPSS. Secondary data
will be used to examine the policies and
welfare Programs.
Objectives with methodology
21. Research Gap
1. In previous studies smaller numbers of variables have been considered to
make analysis on socio-economic determinants among the workers of
unorganized sector but, in this study all the factors related with health
insurance which influence the decision of health insurance schemes will be
considered.
2.According to the research studies on previous a range of literature review
in health insurance but, it is unable to find out any research on effectiveness
of health insurance schemes amongst unorganized workers in Punjab
because, the previous studies are based on the factors and barriers of health
insurance schemes rather than effectiveness of the health insurance schemes
and also there is no any recommendations for the unorganized sector to take
benefits from the health insurance schemes for themselves as well as for
their family members.
22. 3. In this study the willingness of the unorganized sector workers will be
analyzed such as the demand of them will be analyzed as it is not done in the
previous studies.
4.In India, almost 90 percent of people working in the unorganized sector are at
the higher risk due to pandemic situation of COVID-19 it is the important need
of the time to determine the impact of this situation on unorganized workers, so
that further health insurance schemes and benefits will be provided to the
unorganized sector (Yuen et al., 2020).
5. Moreover, because of these measures the twin impact of demonetization and
goods and services tax (GST) will be pushed to the brink hence, this study will
help to find out the needs of the unorganized manufacturing and service sector.
6. This study also includes agriculture sector in rural as well as urban areas to
analyses the impact of health schemes of unorganized sector in Punjab, India.
23. Research Hypothesis
H1:There is no significance difference between the determinants of health insurance schemes among
unorganized sector workers in Punjab.
H2:There is significance difference between the determinants of health insurance schemes among
unorganized sector workers in Punjab.
H3: There is no significance need to study the various health insurance schemes for the unorganized
workers in Punjab.
H4:There is significance need to study the various health insurance schemes for the unorganized sector
workers in Punjab.
H5:There is no significance to analyze the willingness of unorganized sector workers for making the
decision for health insurance schemes.
H6:There is significance to analyze the willingness of unorganized sector workers for making the
decision for health insurance schemes.
H7:There is no significance to formulate the recommendations for unorganized sector workers to
improve awareness for health insurance schemes.
H8:There is significance requirement to formulate the recommendations for unorganized sector workers
to improve awareness for health insurance schemes.
24. Data collection
Secondary Data will be collected from :
Web sites
Previous studies including research papers
Articles in newspapers and magazines
Previous PhD thesis and internet
Primary Data :
Structured Questionnaires
Personal Interview
26. Districts Per Capita Income (2014-15)
Gurdaspur (Majha) 72940(Highest)
Amritsar (Majha) 98599(Lowest)
Nawan Shehar(Doaba) 129366(Highest)
Hoshiarpur (Doaba) 117572(Lowest)
Rupnagar (Malwa) 133707(Highest)
SAS Nagar (Malwa) 132532(Highest)
Ludhiana ( Malwa) 128353(Highest)
Firozpur (Malwa) 86593 (Lowest)
Shri Muktsar Sahib(Malwa) 92786(Lowest)
Mansa (Malwa) 89864 (Lowest)
Per capita Income in different districts in Punjab
27. Proposed Research Methodology contd….
Projected Sample Size
The present study involves the “multi-stage stratified sampling technique”. The first
phase of the sampling technique involves the geographical clustering of Punjab in 3
regions namely Majha, Doaba and Malwa (Taherdoost, 2018).In the second phase, 50
percent of districts will be selected from each of the geographical clusters on the basis of
high and low per-capita income (Aggarwal et al., 2012). Amritsar and Gurdaspur
districts will be selected from the Majha region. Similarly, districts viz. Nawashehar and
Hoshiarpur will be selected from Doaba and lastly, from Malwa region 6 districts will be
selected viz. Ludhiana, Ferozpur, S.A.S Nagar, Mansa, Muktsar and Ropnagar.
29. An outline of selection of sample workers
The unorganized workers are playing vital role in today’s dynamic scenario.
Without, the good health of them it is difficult for developing nation to become
the developed one. To analyze in brief the unorganized sectors are divided into
different sectors. The entire workers are further classified into three main sectors
viz; Agriculture sector, Manufacturing Sector and Service Sector.. These are as: -
Unorganized Sector
Agriculture Sector Manufacturing
Sector
Service
Sector
30. Research Design
RESEARCH TYPE EXPLORATORY RESEARCH
RESEARCH
CONTEXT
UNORGANIZED WORKERS ASSOCIATIONS.
RESEARCH
APPROACH
QUANTITATIVE SURVEY BASED ON LIKERT SCALE
SAMPLING 576 , NON PROBABILITY SAMPLING
DATA TYPE NOMINAL SCALE
VARIABLES OF
STUDY
CRITICAL FACTORS & ACHIEVEMENT VARIABLES
DATA COLLECTION
TOOLS
CUSTOMISED SURVEY INSTRUMENTS
DATA ANALYSIS
TOOLS
DESCRIPTIVE STATISTICS, RELIABILITY TEST, VALIDITY TEST, EXPLORATORY
FACTOR ANALYSIS, NON PARAMETRIC TEST
DATA ANALYSIS
SOFTWARE
SPSS, MS-EXCEL
31. Sampling
Sample Size: The sample size is calculated from both urban and rural area. Adopting
a sample size in scientific approach is become necessary; an ideal sample size is
needed to reduce the sample error and to truly represent the population. For the
present study, Krejcie & Morgan, (1970) formula will be used for sample size.
S=X2NP(1-P)/d2(N-1) +X2P(1-P)
The S denotes as required sample size, x2 represent the table value of Chi-square for 1
degree of freedom at the desired level of Chi-Square for 1 degree of freedom at the
desired level of confidence (3.84). N represented the population size. P as population
proportion and D denotes as degree of accuracy as a proportion (0.50).
Total – According to the Krejcie & Morgan, 1970 table, a sample size of 576 was
achieved which was sufficient to analyze state wide results.
32. Expected Outcomes
It is expected that this research will help to know about the effectiveness of
health insurance schemes among the unorganized sector workers in different
districts of Punjab.
It is difficult to find out the impacts of health insurance schemes on the
economy of the country. As according to previous studies, it has seen that less
than 50% population secured themselves with any kind of health insurance
scheme (Shukla & Singh, 2018). Hence, this study will help to analyze the
impact of health insurance in unorganized sector of Punjab.
This study will help to analyze the reason behind lack of awareness for the
health insurance schemes and also provide assistance to the legislative bodies
to formulate new plans and policies to improve the economic condition of the
country.
33. Relevance of the Expected Results;
The outcome of the study will help to know the reality of health insurance
schemes. So, it would be easy to making appropriate health insurance schemes
for the unorganized sector workers by which the health status and productivity of
the nation can be further improved. It would be also easy to know about the
loopholes in the health insurance schemes for the unorganized sector workers.
Moreover, the study on the effectiveness of health insurance schemes ( An
empirical study) will help to provide awareness among companies and other
policy formulations to make appropriate plans and procedures to make the health
insurance schemes better than before and to analyze the impact of various health
insurance schemes in unorganized sector of Punjab.
34. Tools & Techniques;
The data will be collected by filling the questionnaires of the unorganized sector
workers in Punjab in the rural as well as urban areas. The structured questionnaire
will consist the information/detail about the effectiveness of the health insurance
schemes for the unorganized sector workers in Punjab. The questionnaire will also
sent to the unorganized sector workers through Google forms (G- Forms).
Measurement & Scaling;
The Five- point Likert Scale will be used.
Data collection;
Data will be collected from both Primary as well as Secondary sources. Primary
data will include the interview of unorganized sector workers. For this purpose, 192
workers will be randomly selected from each district making total of 576
unorganized workers from the 3 given regions.
35. Data analysis;
Data will be analyzed with the appropriate statistical techniques by using
software’s like SPSS and R-Programming. The data will also be analyzed
quantatively in tabular form. The data will be analyzed to know the effectiveness
about the health insurance schemes among the unorganized sector workers in
Punjab in rural as well as urban areas. The data will also use to make analysis of
health insurance schemes in different districts of Punjab.
Hypothesis testing;
The suitable Hypothesis test like logistic regression, structural equation
modeling, chi-square test, t-test, confirmatory and exploratory factor analysis
and alpha test and so on will be conducted upon selected data.
36. Timelines of the study;
Proposed time frame
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SOTA committee approval
Data collection
Preliminary study
(reliability and validation)
Annual report submission and presentation
Focus group discussion
Research article submission 1
End term report ( subpresentation)
Research article submission 2
Annual report (sub-presentation)
End term report
Data analysis
Research article submission 3
Compilation of PhD Thesis
Pre-submission registration
Annual report submission and presentation
2020 2021 2022
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