Health Service System in India

Universalising health coverage is the current goal of the health service system in India. Tax-funded insurance for poor families is the method chosen for attaining this objective. The Rashtriya Swasthya Bima Yojana was rolled out in 2008 for households below the poverty line, enabling them to access health services in the public and private sectors. However, experience from different countries shows tax-funded insurance systems work well only in settings where public provisioning of healthcare services prevails. State-funded targeted insurance schemes do not seriously mitigate inequitable access to health services in a fundamentally private healthcare delivery market.

Attainment of universal healthcareaccess is the present goal of the Indian health service system. An insurance-based method of facilitating access to health services has been chosen as the method for attaining this goal. The government in 2008 launched the Rashtriya Swasthya Bima Yojana (RSBY), or the national health insurance scheme, covering all households falling below the state-mandated poverty line. It enlisted the services of the private and public sectors to cater for enrolled households. There further exists a commitment of expanding insurance to cover India’s vast unorganised sector.

This article assesses the practicability of an insurance-based model for attaining universal healthcare access in India. It begins with a brief look at the nature of the health service system in the country, and the expansion of the private sector in the healthcare market in recent times. It then looks at the examples of different countries, which have adopted insurance-based models in their healthcare provisioning systems, followed by a section on the performance of the RSBY in India. It concludes with a mention of the US and Cuban health service systems to help gauge the pitfalls of an insurance-based model vis-à-vis adopting a primary care approach.