Sustainability of Healthcare Insurance in India: A Review of Health Insurance Scheme Launched by States in India

Authors: Mohd Zuhair, Ram Babu Roy

Abstract:

This paper presents an overview of the accessibility, design, and functioning of health insurance plans launched by state governments in India. In recent years, the governments of several states in India have come forward to provide health insurance coverage for the low-income group and rural population to reduce the out of pocket expenditure (OPE) on healthcare. Different health insurance schemes have different structures and offerings which differ in the different demographic factors. This study will portray a comparative analysis of the various health insurance schemes by analyzing different offerings and finance generation of the schemes. The comparative analysis will explain the lesson to be learned from these schemes and extend the existing knowledge of the health insurance in India. This would help in recognizing tension between various drivers and identifying issues pertaining to the sustainability of health insurance schemes in India.

Keywords: Health insurance, out of pocket expenditure, universal healthcare, sustainability.

Digital Object Identifier (DOI): doi.org/10.5281/zenodo.3455693

References:

[1] G. Lagomarsino, A. Garabrant, A. Adyas, R. Muga, and N. Otoo, “Moving towards universal health coverage: Health insurance reforms in nine developing countries in Africa and Asia,” The Lancet, vol. 380, no. 9845. pp. 933–943, 2012.
[2] M. McKee, D. Balabanova, S. Basu, W. Ricciardi, and D. Stuckler, “Universal health coverage: A quest for all countries but under threat in some,” Value Heal., vol. 16, no. 1 SUPPL., 2013.
[3] W. D. Savedoff, D. de Ferranti, A. L. Smith, and V. Fan, “Political and economic aspects of the transition to universal health coverage.,” Lancet, vol. 380. pp. 924–32, 2012.
[4] “World Health Statistics 2012,” WHO, 2012.
[5] R. L. Niëns, Laurens M., Alexandra Cameron, Ellen Van de Poel, Margaret Ewen, Werner B. F. Brouwer, “Quantifying the impoverishing effects of purchasing medicines: A cross-country comparison of the affordability of medicines in the developing world,” PLoS Med., vol. 7, no. 8, 2010.
[6] T. Ahlin, M. Nichter, and G. Pillai, “Health insurance in India: what do we know and why is ethnographic research needed,” Anthropol. Med., vol. 23, no. 1, pp. 102–124, 2016.
[7] K. S. Reddy, V. Patel, P. Jha, V. K. Paul, A. K. S. Kumar, and L. Dandona, “Towards achievement of universal health care in India by 2020: A call to action,” The Lancet, vol. 377, no. 9767. pp. 760–768, 2011.
[8] R. Rezayatmand, M. Pavlova, and W. Groot, “The impact of out-of-pocket payments on prevention and health-related lifestyle: A systematic literature review,” Eur. J. Public Health, vol. 23, no. 1, pp. 74–79, 2013.
[9] M. Zuhair and R. B. Roy, “Socioeconomic Determinants of the Utilization of Antenatal Care and Child Vaccination in India,” Asia-Pacific J. Public Heal., vol. 29, no. 8, pp. 649–659, 2017.
[10] M. S. Yardim, N. Cilingiroglu, and N. Yardim, “Catastrophic health expenditure and impoverishment in Turkey,” Health Policy (New. York)., vol. 94, no. 1, pp. 26–33, 2010.
[11] M. Azam, “Does Social Health Insurance Reduce Financial Burden? Panel Data Evidence from India,” World Dev., 2018.
[12] N. Sood and Z. Wagner, “Social health insurance for the poor: lessons from a health insurance programme in Karnataka, India,” BMJ Glob. Heal., 2018.
[13] “Yeshasvini Cooperative Farmers Health Care Scheme.” (Online). Available: http://www.yeshasvini.kar.nic.in/. (Accessed: 18-Jul-2016).
[14] G. of K. Department Of Cooperation, “Yeshasvini Co-Operative Farmers Health Care Scheme.” (Online). Available: http://sahakara.kar.gov.in/Yashasivini.html. (Accessed: 17-Jul-2018).
[15] C. S. Pramesh, R. A. Badwe, B. B. Borthakur, M. Chandra, E. H. Raj, T. Kannan, A. Kalwar, S. Kapoor, H. Malhotra, S. Nayak, G. K. Rath, T. G. Sagar, P. Sebastian, R. Sarin, V. Shanta, S. C. Sharma, S. Shukla, M. Vijayakumar, D. K. Vijaykumar, A. Aggarwal, A. Purushotham, and R. Sullivan, “Delivery of affordable and equitable cancer care in India,” The Lancet Oncology, vol. 15, no. 6. 2014.
[16] “Rajiv Gandhi Jeevandayee Aarogya Yojana.” (Online). Available: https://jeevandayee.gov.in/MJPJAY/index.jsp#. (Accessed: 19-Feb-2018).
[17] G. of G. Health and Family Welfare Department, “Mukhyamantri Amrutum Yojana.” (Online). Available: http://www.magujarat.com/index.html. (Accessed: 23-Jul-2018).
[18] A. Salado and R. Nilchiani, “The tension matrix and the concept of elemental decomposition: Improving identification of conflicting requirements,” IEEE Syst. J., vol. PP, no. 99, 2015.
[19] A. Salado and R. Nilchiani, “A Set of Heuristics to Support Early Identification of Conflicting Requirements,” INCOSE Int., no. JANUARY, 2015.
[20] I. T. Olsen, “Sustainability of health care: A framework for analysis,” Health Policy Plan., vol. 13, no. 3, pp. 287–295, 1998.
[21] S. Reddy and I. Mary, “Aarogyasri Scheme in Andhra Pradesh, India: Some Critical Reflections,” Soc. Change, vol. 43, no. 2, pp. 245–261, 2013.
[22] S. Bergkvist, A. Wagstaff, A. Katyal, P. V Singh, A. Samarth, and M. Rao, “What a difference a state makes: health reform in Andhra Pradesh.,” Policy Research Working Paper - World Bank, no. 6883. p. 57–pp, 2014.
[23] K. Arrow, “Uncertainty and the welfare economics of medical care,” The American economic review. pp. 941–973, 1963.
[24] M. V. Pauly, “The Economics of Moral Hazard: Comment,” Am. Econ. Rev., vol. 58, no. 3, pp. 531–537, 1968.
[25] J. A. Nyman, “The value of health insurance: The access motive,” J. Health Econ., vol. 18, no. 2, pp. 141–152, 1999.
[26] T. Besley, “The Demand For Health Care And Health Insurance,” Oxford Rev. Econ. Policy, vol. 5, no. 1, pp. 21–33, 1989.
[27] P.-A. Chiappori and B. Salanie, “Testing for Asymmetric Information in Insurance Markets,” J. Polit. Econ., vol. 108, no. 1, pp. 56–78, 2000.
[28] D. M. Cutler and F. Scott Morton, “Hospitals, Market Share, and Consolidation,” Jama, vol. 310, no. 18, p. 1964, 2013.
[29] J. O. Schmidt, T. Ensor, A. Hossain, and S. Khan, “Vouchers as demand side financing instruments for health care: A review of the Bangladesh maternal voucher scheme,” Health Policy, vol. 96, no. 2. pp. 98–107, 2010.
[30] I. Gupta, J. William, and S. Rudra, “Demand side financing in health. How far can it address the issue of low utilization in developing countries?,” World Heal. Rep., pp. 1–34, 2010.
[31] W. C. Hsiao, “Why is a systemic view of health financing necessary?,” Health Affairs, vol. 26, no. 4. pp. 950–961, 2007.
[32] V. Patel, R. Parikh, S. Nandraj, P. Balasubramaniam, K. Narayan, V. K. Paul, A. K. S. Kumar, M. Chatterjee, and K. S. Reddy, “Assuring health coverage for all in India,” The Lancet, vol. 386, no. 10011. pp. 2422–2435, 2015.
[33] C. E. van Dijk, J. D. de Jong, R. A. Verheij, T. Jansen, J. C. Korevaar, and D. H. de Bakker, “Compliance with referrals to medical specialist care: patient and general practice determinants: a cross-sectional study.,” BMC Fam. Pract., vol. 17, p. 11, 2016.