Catastrophic health spending in India has remained high over the past 15 years despite the introduction of large and comprehensive social health insurance schemes (Pandey et al 2018, 2018b). Understanding why these schemes have not improved financial risk protection is a pressing concern as India advances towards universal health coverage.
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 cover, and how to access scheme benefits.
