Government-Sponsored Health Insurance in India : Are You Covered?

La Forgia, Gerard ; Nagpal, Somil

关键词: Financial protection;    Health financing;    Health insurance;    Health provision;    Health coverage;   

DOI  :  10.1596/978-0-8213-9618-6
RP-ID  :  72238

学科分类：社会科学、人文和艺术（综合）

来源: World Bank Open Knowledge Repository

【 摘 要 】

Since independence, India has struggledto provide its people with universal health coverage.Whether defined in terms of financial protection or accessto and effective use of health care, the majority of Indiansremain irregularly and incompletely covered. Finally, andmost recently, a new generation of Government-SponsoredHealth Insurance Schemes (GSHISs) has emerged to provide thepoor with financial coverage. Briefly, the main objective ofthese new GSHISs was to offer financial protection againstcatastrophic health shocks, defined in terms of an inpatientstay. Between 2007 and 2010, six major schemes have emerged,including one sponsored by the Government of India (GOI) andfive state-sponsored schemes. This new wave of schemesprovides fully subsidized coverage for a limited package ofsecondary or tertiary inpatient care, targeting belowpoverty populations. Similar to the private voluntaryinsurance products in the country, ambulatory servicesincluding drugs are not covered except as part of an episodeof illness requiring an inpatient stay. The schemes haveorganized hospital networks consisting of public and privatefacilities, and most care funded by these schemes isprovided in private hospitals. Ostensibly, the objective ofany health insurance scheme is to increase access,utilization, and financial protection, and ultimatelyimprove health status. Due to lack of evaluations andanalyses of household data, the authors of this book do notexamine the impact of health insurance in terms of theseobjectives. This book is not meant to highlight problems ofthe GSHISs, but rather to raise potential challenges andemerging issues that should be addressed to ensure thelong-term viability of these schemes and secure their placewithin the health finance and delivery system.