Global health policy advocates suggest that health insurance could provide a safety net to low-income families by reducing financial risk, improving access to care for better health outcomes. To achieve such UHC outcomes, the national and state governments in India have launched several government-funded health insurance schemes (GFHIS) in the past decade. The GFHISs promise to cover the below poverty line (BPL) families with minimal/no contribution from beneficiaries. Considering the limitations of existing evidence around enrolment/coverage of these GFHISs across states/ regions/ districts, this study presented a historical evolution of GFHIs in India followed by enrolment/ coverage status of households/families, depth of benefit coverage and the funding and financing mechanism of GFHIs using official and national level large scale survey data.
- The current health insurance system in India can be classified as employer-mandated social health insurance (SHI) like CGHS and ESIS, commercial/voluntary health insurance (VHI), community-based health insurance, and target-oriented government-funded health insurance (GFHI), varying considerably in terms of nature and coverage.
- The share of Health Insurance in Total Health Expenditure for India has increased from 2.7% in 2004–05 to 8.13% in 2015–16. Out of the total contribution through health insurance, 51% is accounted for by private health insurance, 37% by social health insurance (SHI) and 12% by government health insurance (GHI).
- The analysis shows a difference in cover provided by government and employers supported SHI and GFHI schemes. The SHI comprehensively covers both inpatients as well as outpatient treatment expenses. On the other hand, GFHI schemes are limited only to inpatient care.
- The overall analysis from different survey data reveals high diversity in coverage across quintiles, rural-urban and less-high educated. In IHDS-2012, around 2.65 crores (10.38%) households found to have RSBY, while NSS-2019 reflect 3.48 crore (13.3%) households have GFHIs – 68.2% less than the claim made by the governments in official data.
The penetration of various scheme is recorded high among non-poor and urban as compared to their other counterparts with a wide variation across states/ districts, posing serious challenge for ensuring equitable access to healthcare to the country population. The health service delivery through the insurance model, however, is emerging in our country, but the contribution of insurance in financing total health expenditure is substantially low. It is the OOP that still constitute the higher share in financing health expenditure.
Read more at Hooda SK. Penetration and coverage of government-funded health insurance schemes in India. Clin Epidemiol Glob Heal [Internet]. 2020;8(4):1017–33. Available from: https://doi.org/10.1016/j.cegh.2020.03.014
