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

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Experiences with Government-sponsored Health Insurance Schemes in Indian States

The implications of expanding government-sponsored health insurance schemes in India are analysed from a fiscal perspective. The experiences of two of the earliest and largest GSHI schemes of the country implemented in Andhra Pradesh and Tamil Nadu are examined. The results suggest that the expansion of the GSHI schemes may skew expenditure away from primary and secondary care towards tertiary care if the fiscal space is limited. A competitive public health system may help in containing costs and the corresponding fiscal burden. The effectiveness of public spending through such schemes is ambiguous.

COVID-19, Health Insurance and Access to Healthcare

Addressing the COVID-19 pandemic with a robust healthcare system, and effective government intervention with appropriate regulation on private sector, is a more appropriate option than resorting to insurance to cover COVID-19 related care, or healthcare in general.

Evaluating Health Insurance Programmes

An array of bottlenecks has ensured that the numerous health insurance schemes introduced over the years have failed to make any significant dent on the health sector. This article tries to assess these problems by using the “insurance cascade,” a framework that traces the steps from enrolling eligible households to ultimately delivering their benefits. The existing evidence suggests substantial bottlenecks across all cascade steps, with especially large gaps in beneficiaries’ awareness of how to enrol in schemes, what the schemes covers, and how to access scheme benefits.

From RSBY to PMJAY

Healthcare for India’s Poor: The Health Insurance Way by Sonalini Khetrapal, New Delhi, Gurugram: Academic Foundation, 2019; pp 192, ` 1,195.

Risky Insurance: The Pradhan Mantri Jan Arogya Yojana in Jharkhand

A ground-level survey of the Pradhan Mantri Jan Arogya Yojana in Jharkhand reveals that the scheme nudges patients towards the private sector under the guise of free healthcare only for them to incur exorbitant expenditure over the course of treatment.

Estimates of Health Insurance Coverage in India

Financing health expenditure through health insurance is currently gaining significance as a strong social policy in countries like India where public health facilities are still inadequate. An attempt to estimate the coverage of health insurance in India shows that the coverage is low and not uniform across states and union territories, despite the fact that several public-funded schemes focus on the below poverty line population. Of the various types of health insurance schemes, public-funded health insurance schemes have a dominant position. Moreover, the likelihood of health insurance coverage is relatively higher among specific social groups and in certain areas.

Ayushman Bharat and the False Promise of Universal Healthcare

What implications will a health insurance scheme that relies on private capital have for India’s healthcare system?

Flaws of Insurance-based Healthcare Provision

Tamil Nadu is recognised for its achievements in human development, especially in the area of healthcare. In light of the central government’s recent move to launch insurance-based targeted healthcare provision, a case is made for paying attention to building public health infrastructure based on Tamil Nadu’s experience with healthcare provisioning. The pitfalls of insurance-based provisioning and targeting, and the need to recognise regional trajectories and institutional innovations in this regard are highlighted.

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.

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.

Health Insurance, Health Access and Financial Risk Protection

Drawing from the 60th and 68th rounds of National Sample Survey Office, this study evaluates the impact of different (social, commercial and target-oriented) health insurance schemes on access to healthcare use, and cost of care and financing of medical expenses. The results show that though these schemes promote access to healthcare, they also increase the costs manifold. The commercial insurers have not been effective at pooling financial risks and seem to be indulging in maximising individual gain. Given the intrinsic market-failure and information asymmetry between the principal and the agents and difficulties in regulating the insurance-base system, this study advocates financing healthcare through a tax-based system which can be cost-effective for achieving universal healthcare access in India.

Draft National Health Policy 2015

This paper contributes to the debate on the Draft National Health Policy 2015 by analysing and critiquing some of its key recommendations within the prevailing social, economic, and political context of the country. This policy seems to suggest that strategic purchasing of curative health services from both the public and private sectors can enable India to achieve the goal of "universal healthcare." The draft policy is based on two assumptions. One, policy interventions since the National Health Policy 2002 have been largely successful and two, there is harmony of purpose between public and private healthcare delivery systems which allows the private sector to be used for achieving public health goals. This article argues that these assumptions are flawed, highlights the various contradictions in the policy and cautions against over-optimism on publicly-financed health insurance schemes.

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