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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.
The Rashtriya Swasthya Bima Yojana (RSBY) was launched in 2008 and had a target of covering the entire population below poverty line (BPL) by 2012. However, even after nine years of its implementation, only half of the BPL families were covered according to the government’s own data. Further, there is a huge discrepancy between the coverage figures given by the government data and estimates from surveys. For example, as per the 71st round of National Sample Survey Office (NSSO), 11.1% of population was covered by the RSBY and state-sponsored health insurance schemes (SSHIS) in 2014 (excluding Employment State Insurance Scheme (ESIS), Central Government Health Scheme (CGHS) and Ex-Servicemen Contributory Health Scheme (EcHS)) but data from Insurance Regulatory and Development Authority (IRDA) suggests that the population coverage of these schemes was 16.4%.
One of the major sources of this discrepancy in enrolment rate in the RSBY is due to the creation of bogus beneficiaries by the insurance companies to earn premium subsidy from the government. Another source of discrepancy is that while insurance companies have been given the premium subsidy for covering all eligible households in respective states, the insurer did not reach out to all and only a fraction of the eligible population was enrolled and made aware about their entitlements under various SSHIS. For example, total eligible families for the Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY) in Maharashtra, as per the public distribution system (PDS) data, were 2,07,94,294 in 2015, of which merely 2.45% families were enrolled under the scheme in 2016.
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