Three Essays on Demand-side Health Policies in India

Demand-side health policies, such as conditional cash transfers and public health insurance, aim to increase the utilization of healthcare services by providing financial incentives and higher purchasing power to under-served populations. With their increasing popularity in developing countries, there is a need for more research on their implementation and impact. In this dissertation, I examine demand-side health policies in India by evaluating the impact of these policies, identifying challenges in their implementation and proposing ways to improve their effectiveness in increasing utilization of healthcare services. In the first chapter, I measure the impact of conditional cash transfers on health-seeking behaviors. I study the rollout of the Indira Gandhi Matritva Sahyog Yojana (IGMSY or the motherhood support program), a conditional maternity benefits program implemented in 52 of India’s 640 districts in 2011. I estimate the effect of this program on three health-seeking behaviors among pregnant women (at least one tetanus shot, at least one antenatal checkup and full immunization of child) by using a border discontinuity design. I compare the levels of health-seeking behaviors among births in villages along the borders of districts that received the program with those across the border in districts that did not receive the program. I do not find any large significant differences in health-seeking behaviors among births in districts that received the program. In the second chapter, I further examine the results from the first chapter by conducting a qualitative study to identify challenges in the implementation of conditional cash transfer programs aimed at improving maternal and child health in India. I interview 147 beneficiaries and 24 administrators in four districts that received the program. These districts include one high, one medium and two low performing districts. Besides discussing the overall implementation of the program (levels of awareness, the application process and payment of benefits), I identify three themes that help explain the poor implementation of the program: high administrative burdens on beneficiaries, the reluctant role of street-level bureaucrats and low administrative capacity at the sub-district level. In the third chapter, I propose a method to increase awareness about demand-side health programs to increase the utilization of healthcare services among intended beneficiaries. I design an intervention to increase levels of awareness about availing benefits under the Rashtriya Swasthiya Bima Yojana (RSBY or the national health insurance program) among enrolled beneficiaries. I evaluate the effectiveness of village-level awareness meetings in increasing utilization of program benefits by conducting an experiment in 61 villages of Chamarajanagara district in southern India. I find that village-level awareness meetings not only increase the utilization of health insurance benefits but also provide government agencies a unique opportunity to monitor program implementation in remote locations