(GIST OF YOJANA) Health Insurance in India - September-2017

(GIST OF YOJANA) Health Insurance in India - September-2017

Health Insurance in India

Countries such as' Brazil, Bolivia, Indonesia and Thailand, all characterised earlier by situations of high inequality and uneven access to health care systems, have revamped policies since the 1980s towards universal health care. The 30 baht scheme in Thailand, decentralisation reforms and social health insurance in Indonesia, and the unified health system in Brazil provide examples of how countries have addressed basic health requirements of the entire population. These examples indicate that strengthening of the primary health care system is a prerequisite for achieving universal health coverage.

Health insurance in India began with Employment State Insurance Scheme (ESIS) and the Central Government Health Scheme (CGHS) that cater to government employees and their dependants. These schemes focus on high-end secondary and tertiary care and together provide protection to less than 10 per cent of the India's population working in public sector undertakings.

A conditional cash transfer scheme Janani Suraksha Yojana (JSY) was introduced in 2005 to encourage institutional deliveries among poor women in rural areas. The scheme led to substantial improvement in institutional delivery, particularly in poorer states, though it has not necessarily translated into a reduction in the maternal mortality rate.

The Rashtriya Swasthiya Bima Yojana (RSBY) was launched in 2008, to provide financial protection against catastrophic health expenditure for vulnerable groups and to ensure better access to quality health care for people below the poverty line. Though initially the scheme was to cover only BPL families, it was. extended to vulnerable groups in the informal sector such as rickshaw pullers and rag pickers. The scheme provides a coverage of Rs. 30000 in case of hospital based inpatient care, on an annual registration fee of Rs. 30 by the beneficiary for the family. The coverage limit has recently been enhanced to one lakh rupees. RSBY coverage as on end March 2016 was 41.3 million families out of an eligible 72.8 million families. Total hospitalization cases however were only 11.8 million pointing to low utilisation of the scheme. Further, evidence from the field indicates that one of the main desired outcomes of the RSBY, to reduce the financial burden of health expenditure among the poor, may not have been realized and Out- of-Pocket (OOP) expenditures have not diminished" owing to payments for drugs and diagnostics and other inpatient services not covered by RSBY, additional transport expenses and the like. The RSBY performance is better in states such as Kerala, that have built a good health care infrastructure.

Atleast eight state governments are operating health insurance schemes, prominent among them being Vajpayee Arogyashri Scheme (VAS) for BPL families and Yeshasvini Cooperative Farmers Healthcare Scheme in Karnataka, Rajiv Gandhi Arogyasri Scheme (RAS) in Andhra Pradesh (including Telangana), CM Health Insurance Scheme in Tamil Nadu, Rajiv Gandhi Jeevandayee Arogya Yojana in Maharashtr a, Mukhyamantri Amrutam Yojana in Gujarat, and Sanjeevani Kosh in Chhattisgarh. Of these, RAS of Andhra Pradesh with 8.5 per cent coverage is closest to universal health care. However, due to its orientation towards secondary and tertiary care, nearly half of the payments were for cardiac, cancer and kidney failure whereas for the poorest 40 percent of the population, the burning issues continue to be premature mortality and disability due to lower respiratory infections, diarrheal diseases, tuberculosis and ischemic heart disease, all of which need attention and can actually be treated at the primary level. Overall, as of 2015, some form of health security is being provided to more than 280 million or about one fourth of the population, through insurance programmes run by the government, viz., CGHS, ESIS, state specific insurance schemes, and RSBY. However, none of the central or the state level insurance schemes cover primary care in the insurance package, with the exception of Meghalaya that provides partial coverage. All of Achieving universal health coverage is listed as care.
goal 3.8 in the Sustainable Development Goals agenda for 2030. India's performance holds the key to achieving this global aspiration. The Government

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