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Health insurance a predominant medium for achieving universal healthcare in India ? A farfetched dream?

In India, there are two kinds of insurances - Social Health Insurance (e.g. Employees State Insurance Scheme) & Voluntary Health Insurance. Even after years of grappling with health insurances, 71% of the healthcare costs are borne by the households. CGHS (Central Government Health Scheme), ESI (Employees State Insurance) and private insurance providers are major participants but they often ignore the population that needs the healthcare insurance the most. Self Help Groups and NGOs extend a number of Community based health insurance schemes. However, this covers only less than 1% of the country?s population. ESIS and CGHS taken together constituted 41% of total spending on insurance. The government has rolled out various schemes like RSBY (Rashtriya Swasthya Bima Yojna) that cover population in informal sector but only the BPL (Below Poverty Line) and marginalized population. Still a large non-formal sector is there that is above the BPL but in dire need of health insurance as they are most susceptible to catastrophic health expenditures and fall below poverty line due to health expenditures. However, achieving universal coverage through compulsory health insurance has several roadblocks like a huge informal sector, uneven income levels, large rural population and variability in government policies. When it comes to healthcare service delivery, private providers account for majority of healthcare expenditure (76.74%). While in the public sector, the major providers are public hospitals, outreach centres, medical education, research and training institutes. A comprehensive health insurance scheme is needed instead of fragmented schemes to provide universal health coverage to the whole population. This short commentary tries to throw light on the inequity of healthcare insurance and service delivery in a complicated healthcare system of urban areas.

Author(s): Akanksha Rathi