Health Insurance Coverage

Rs18,000 Crore Required as Investment to Extend Health Insurance Coverage

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The magnitude of disease to be covered and the amount of the population government can finance or subsidize would ultimately depend on the resources that can be allocated toward this.

Contributing around Rs 18,000 crore or 0.2% of the GDP efficiently can aid India in extending basic health insurance coverage to almost 80% of the population, according to a CII healthcare subcommittee.

The CII study, which emphasizes that there must be a roadmap for Universal Health Coverage (UHC), assuming an average annual premium of Rs 900 per family, where it is supposed that each family has five members and administrative costs are excluded. The health ministry is currently seeking the opinion of stakeholders including states and development agencies on evolving the most suitable 'health assurance for all' plans for the nation.

Post taking over last month as union health minister, Harsh Vardhan had promised health insurance for everyone. It has been estimated that at any given point of time, less than 5% of the population requires hospitalization. India can turn its large population base into an asset and utilize its demographic dividend to its advantage while rolling out UHC.

The demographic dividend is defined as that period when the share of young and working people in a country's population exceed dependents substantially.

The Centre currently runs several health insurance schemes such as Rashtriya Swasthya Bima Yojana (RSBY), Central Government Health Scheme (CGHS) and Employee State Insurance Scheme (ESIS), while states like Andhra Pradesh Tamil Nadu, Karnataka operate their own programmes, often replicating efforts at a time when resources are less.

It is mandatory to bring all schemes under one umbrella for efficient pooling and management. The CII paper suggests that the premium per family for secondary and tertiary care shall be less than Rs 900 per family and proposes that health insurance be used to offer a secondary care package of Rs 60,000 topped by a tertiary care package of Rs 2 lakh.

The magnitude of disease to be covered and the amount of the population government can finance or subsidize would ultimately depend on the resources that can be allocated toward this.

Health insurance must be made mandatory and even though a free-for-all UHC is an ideal case, we believe this would procrastinate the process of universalism. Therefore, people above the poverty line, self-employed and employed in the formal sector should pay for secondary and tertiary level cover while government funds should be utilized to provide cover to the poor and vulnerable sections. Primary healthcare should be continued to be available free of cost.

The study by the industry chamber tells that developing a self-paying segment can improve the accountability of delivery system; as such a customer is often more demanding than a beneficiary who receives free benefits.

A suitable UHC plan for India has to be a proper mix of contributory and welfare system which emphasizes on expanding coverage to the under privileged rather than capping the affluent.

India, with 21% of the global burden of disease but only 6% of hospital bed capacity, has been left behind Asian neighbors Thailand, Indonesia, China on UHC, Bali added, calling for a dramatic and innovative healthcare reform process in the country.

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