India would have more than 630 million people covered under health insurance by 2015, said a World Bank study. The study said that the new generation of government-sponsored health insurance schemes (GSHISs) were introducing explicit entitlements, improving accountability and leveraging private capacity, particularly with an aim of reaching the poor.
The World Bank study, 'Government-Sponsored Health Insurance in India: Are You Covered?', has analysed the findings from three central-level schemes and six state schemes. This The included Employees State Insurance Scheme (ESIS), Rashtriya Swasthya Bima Yojana (RSBY), and Central Government Health Scheme (CGHS). The state level schemes analysed were Rajiv Arogyashri (Andhra Pradesh), Yeshasvini (Karnataka), Vajpayee Arogyashri (Karnataka), Chief Minister Kalaignar’s Scheme (Tamil Nadu-later re-launched as Chief Minister’s Comprehensive Health Insurance Scheme), RSBY Plus (Himachal Pradesh), and the proposed Apka Swasthya Bima Yojana (Delhi).
"The study has come about at a highly opportune time as India plans to significantly increase public spending on health to spearhead India’s march towards universal health coverage," said Keshav Desiraju, Special Secretary, Ministry of Health and Family Welfare.
According to the study, over the last five years, government sponsored schemes have contributed to a significant increase in the population covered by health insurance in the country, scaling up at a pace possibly unseen elsewhere in the world. It said that through their efforts, over 300 million people, or more than 25% of India’s population, gained access to some form of health insurance by 2010, up from 55 million in 2003-04.
Given these trends, the study projected that by 2015, about half of the country’s population, can be covered with some form of health insurance. In 2015, spending through health insurance is also likely to reach 8.4 percent of total health spending, up from 6.4 percent in 2009–10, the study said.
"The new generation of government-sponsored health insurance schemes is improving the use of public resources for health, especially for the poor. This is heartening since out-of pocket payments on health accounts for nearly 69% of all health spending in India, posing serious financial burden for the poor and vulnerable communities," said Onno Rûhl, World Bank Country Director for India.
The study pointed out that some of the innovative features common to all the new generation GSHISs included patients' choice to visit any public or private provider empanelled by the government, fully cashless facility and use of pre-agreed package rates for payment among others. It cited the example of Kerala and Andhra Pradesh, where schemes were providing public hospitals with an additional source of financing which was being used to upgrade infrastructure and introduce new services.
The study, however, pointed out that coverage remained far from comprehensive as the schemes focused on inpatient, often surgical care. "Besides working on deepening their benefit package, GSHISs also need to address several operational constraints," the study said. It recommended increasing health insurance coverage for both outpatient and in-patient care to include all poor and near-poor patients. It also suggested a balanced approach, building upon the public infrastructure already available, augmenting it with accessible private capacity and utilizing the lessons learned from the GSHISs.
"This study, we hope, will help the government undertake the steps required to strengthen and expand government-supported health insurance as well as improve the broader health financing and delivery systems," said Rûhl.
