Health Insurance

This paper contributes to the debate on the Draft National Health Policy 2015 by analysing and critiquing some of its key recommendations within the prevailing social, economic, and political context of the country. This policy seems to suggest that strategic purchasing of curative health services from both the public and private sectors can enable India to achieve the goal of "universal healthcare." The draft policy is based on two assumptions. One, policy interventions since the National Health Policy 2002 have been largely successful and two, there is harmony of purpose between public and private healthcare delivery systems which allows the private sector to be used for achieving public health goals. This article argues that these assumptions are flawed, highlights the various contradictions in the policy and cautions against over-optimism on publicly-financed health insurance schemes.

This paper proposes an approach to periodically measure the extent of progress towards universal health coverage using a set of indicators that captures the essence of the factors to be considered in moving towards universalisation. It presents the rationale for the approach and demonstrates its use, based on a primary household survey carried out at the district level. Discussing the strengths and limitations of the approach, it points to how these measures could be further refined. The effort is to find a method of measurement that will apply to any of the alternative ways of progressing towards universal health coverage, however defined and implemented.

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.