Study to assess impact of health reform in India

A University of Chicago professor in law and medicine is helping the nation of India assess the results of a massive health reform program targeting its poorest populations, as the government considers whether to extend the 5-year-old effort.

Anup Malani is currently conducting several interdisciplinary studies involving 60,000 residents spread across hundreds of villages in the state of Karnataka, India, beneficiaries of a new health insurance program called Rashtriya Swasthya Bima Yojna (RSBY) that could ultimately apply to more than 300 million people. Malani hopes to use this large-scale research effort to help establish a center at the University of Chicago to study international health care economics and policies.

Whether to do so, and, if so, how are huge questions.

“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,” said Malani, the Lee and Brena Freeman Professor at the UChicago Law School and a professor at the Pritzker School of Medicine. “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 said. Preliminary results are expected by mid-2014.

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 UChicago, 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.

In the United States, 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—10 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,” Malani said. “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.”

UChicago’s Arete Initiative has helped Malani and his coworkers define the center’s mission and identify key foundations that might be interested in supporting the work. Arete launches large-scale projects that typically cross departmental, divisional, disciplinary and even institutional divides.

“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 said. “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,” said Malani, who has a PhD in economics and a law degree, both from UChicago. “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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