ISSN (Print) - 0012-9976 | ISSN (Online) - 2349-8846

Soumitra GhoshSubscribe to RSS - Soumitra Ghosh

Role of Government in Funded Health Insurance Schemes

State-funded health insurance schemes do not target the truly needy or completely miss them, while the government is unable to regulate the private sector. These aspects were not taken into account when the government announced the National Health Protection Scheme. The scheme will turn out to be just another means for the growth of the private sector in the secondary and tertiary care segments.

Publicly Financed Health Insurance Schemes

The announcement of the National Health Protection Scheme provides us with an opportunity to see how its predecessor Rashtriya Swasthya Bima Yojana and other publicly funded health insurance schemes have fared so far. The experiences of PFHIS indicate that targeted health insurance coupled with a healthcare delivery system dominated by “for profit” private providers failed to address the issues of access and financial risk protection. They possibly displace resources that can be utilised for strengthening a public health system.

Compensatory Afforestation

Compensatory afforestation is a dubious and controversial environmental “offset” that is adding to environmental damage instead of mitigating or compensating it. Compensatory afforestation may actually be accelerating the invasion of India’s forests by big corporations, in collusion with a permissive state, by legitimising the destruction of forests, greenwashing the land grabs, and encroaching on common property resources and community-held lands. This article is based on a study of the Polavaram multipurpose project in Andhra Pradesh, the Durgapur mines in Maharashtra, the Teesta hydroelectric project in Sikkim and the Lower Subansiri hydroelectric project in Arunachal Pradesh.

Targeting and Effects of Rashtriya Swasthya Bima Yojana on Access to Care and Financial Protection

This article provides evidence on the impact of the Rashtriya Swasthya Bima Yojana on access to healthcare and financial risk protection; its coverage across selected states and whether the targeting is effective. Overall, just about 11% of households were enrolled and almost half of these households actually belonged to the non-poor category. Although the scheme has increased hospitalisation rate, we do not know if it has enabled people to access the “genuinely needed” inpatient care which they could not afford earlier or whether hospitals are inducing the demand by suggesting unnecessary inpatient care to the people. Disturbingly, it has hardly had any effects on financial protection. These evidences unequivocally indicate that targeted health insurance coupled with a healthcare delivery system dominated by private providers cannot be the means to achieve universal healthcare.

Capitalisation of Nature

Trading in environmental commodities like various forms of "offsets" has started with its questionable premise that any loss or damage to environment at a particular space-time can be offset by a supposedly pro-environmental action in another space-time through the mediation of capital and market. In India, a rather disguised offset process known as compensatory afforestation has taken off under state and judicial patronage quite some time ago. Besides, India also has the strong credential of having hosted a more common form of offset trading in the Clean Development Mechanism. Referring briefly to both but discussing mainly the philosophy and practices of various forms of offset markets in vogue, this article tries to show that this concept is in sync with the evolution of capital and capitalism in history.

Publicly-Financed Health Insurance for the Poor

Evaluating the effectiveness of the "targeting" approach in the Rashtriya Swasthya Bima Yojana, the present study examines the determinants of enrolment, hospitalisation and financial protection for below the poverty line households using data from a large-scale survey conducted in Maharashtra in 2012-13. Almost 50% of BPL households were found to be non-poor and only 30% of them were aware about RSBY. More importantly, the effect of RSBY on catastrophic health expenditure was not found to be statistically significant. Since commercial insurance companies and their third party administrators have limited interest in awareness generation and enrolment, their role may be reviewed and instead an independent public agency should be given responsibility for enrolment of unorganised sector workers. This would be a key step towards achieving universal population coverage. However, in the long run, the government should strengthen the resource-starved public health system.

Catastrophic Payments and Impoverishment due to Out-of-Pocket Health Spending

Out-of-pocket payments are the principal source of healthcare finance in most Asian countries, and India is no exception. This fact has important consequences for household living standards. In this paper the author explores significant changes in the 1990s and early 2000s that appear to have occurred as a result of out-of-pocket spending on healthcare in 16 Indian states. Using data from the National Sample Survey on consumption expenditure undertaken in 1993-94 and 2004-05, the author measures catastrophic payments and impoverishment due to out-of-pocket payments for healthcare. Considerable data on the magnitude, distribution and economic consequences of out-of-pocket payments in India are provided; when compared over the study period, these indicate that new policies have significantly increased both catastrophic expenditure and impoverishment.

Fake Stereotypes

We are dismayed by the editorial “Protecting India’s Protected Areas”, written by Praveen Bhargav and Shekar Dattatri (23 April 2011), and are particularly shocked that EPW chose to give this note space in the editorial section. The editorial questions two recommendations of the Saxena Committee on...
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