Role of Government in Funded Health Insurance Schemes

State-funded health insurance schemes do not target the truly needy or completely miss them, while the government is unable to regulate the private sector. These aspects were not taken into account when the government announced the National Health Protection Scheme. The scheme will turn out to be just another means for the growth of the private sector in the secondary and tertiary care segments.

The authors thank the conference presenters/contributors and participants at the National Conference on Health Insurance and Universal Health Care in India, organised by Centre for Enquiry into Health and Allied Themes, and Tata Institute of Social Sciences in Mumbai in October 2017.

All the existing national- and state-level publicly funded insurance schemes in India have identified target populations that are eligible for the particular schemes. However, several schemes have in fact resulted in mis-targeting or missing the target altogether (Ghosh and Datta Gupta 2017; Rent and Ghosh 2015; Wagle and Shah 2017). There is a fundamental problem with using the below poverty line (BPL) lists, as the criteria for inclusion and exclusion are faulty. For instance, widows or women-headed households tend to get excluded. There is also no realistic understanding of urban poverty for the purpose of the lists. These lists are also not updated regularly, excluding those who have been recently impoverished.

Thus, these schemes do not take into account the fact that there are existing social exclusionary processes that exacerbate the situation for the vulnerable and marginalised, and therefore they are unable to gain any benefit from these. Migrants, tribals, and deserted or widowed women were found less likely to be covered by insurance schemes. The inability of the schemes to provide coverage to the eligible population is highlighted by the fact that enrolment rates are as low as 2.45% as in the case of the Rajiv Gandhi Jeevandayee Aarogya Yojana (RGJAY) (Wagle and Shah 2017) and less than 5% in several states under the Rashtriya Swasthya Bima Yojana (RSBY) (Ghosh and Datta Gupta 2017).