Dr. Shailender Swaminathan, from Public Health Foundation of India, New Delhi will be delivering a seminar titled "The Impact of the Introduction of Government Health Insurance Programs on Health and Borrowing: Evidence from the Medicare Program in the United States and the RSBY Program in India". 

Abstract

Medicare: Medicare is a health insurance program for the elderly (age greater than or equal to 65) in the United States. The program was introduced in 1966 and immediately provided coverage to over 19 million individuals. We assess the effects of Medicare in the first seven years after its passage (1966 to 1972). Specifically, we examine the impact of Medicare-provided insurance for inpatient visits on the hospital insurance and utilization rates, health, and mortality rate of the newly insured. The analysis applies an “age discontinuity” design to data both before and after Medicare’s introduction. We find that Medicare: i) increased hospital utilization and costs among the elderly, but at a lower rate than previously found; and ii) significantly increased life expectancy in the eligible population. The mortality reductions exhibit an age discontinuity only after Medicare's introduction – patterns not found in nations that did not introduce a Medicare-style program in the 1960’s – with deaths due to heart disease and stroke accounting for most of these reductions. We estimate that Medicare’s introduction had a cost-per-life year ratio below $200 (in 1982-84 dollars).

RSBY program in India: The Rashtriya Swasthya Bima Yojana (RSBY), introduced in 2008, represents India’s first major effort to introduce health insurance coverage to the population. The program covers roughly 37 million households and over 120 million individuals identified as being below the poverty line (BPL).Using household-level survey data from the National Sample Survey Organization (NSSO) collected both before-and-after the introduction of RSBY, we use quasi-experimental designs to examine the investigate the impact of RSBY both on inpatient hospitalization and on borrowing. We find that RSBY resulted in an increase in inpatient hospitalization as well as a decrease in borrowing to meet health expenses. We further present preliminary evidence from an ongoing, large-scale randomized experiment to estimate the causal impact of RSBY on both hospitalization rates as well as borrowing. 

About the Speaker

Dr. Shailender Swaminathan is an economist and a research scientist at the Public Health Foundation of India and an Adjunct Faculty at Brown University, Providence, USA. His primary research interests are in the area of applied microeconomics with a particular emphasis on health. His current work examines the impact of several policies that are directed towards expanding health insurance coverage. Among other projects, he plans to work on two key current issues that are the focus of current policy efforts of the Government of India (a) Universal Health Coverage, and (b) Financing of dialysis care. The rapid increase in the rate of chronic diseases in India has brought the focus squarely upon mechanisms for financing health care. Using experimental and quasi-experimental designs, his work seeks to bring robust evidence to bear on policy-relevant questions.

His work has been published in several journals. He has also been the principal investigator on multiple grants awarded by the U.S. National Institutes of Health. In 2009, a paper he co-authored with other colleagues won the prize for the “Best Paper in the area of Health Policy”. Over the 15 years, Dr. Swaminathan has taught several courses at both the undergraduate and graduate levels- e.g., macroeconomics, econometrics, and health economics.