Case histories

Case histories

Context:

• The government’s intention to launch the world’s largest health insurance programme, the National Health Protection Scheme, raises an important issue.

Issues:

1-   Should the focus be on the demand side of health-care finance when the supply side, the public health infrastructure, is in a shambles?

• Experience with insurance schemes, such as the Centre’s Rashtriya Swasthya Bima Yojana and Andhra Pradesh’s Rajiv Aarogyasri, show how demand side interventions can miss the mark.
• The RSBY and Aarogyasri failed to reach the most vulnerable sections. At times they led to unnecessary medical procedures and increased out-of-pocket expenditure for poor people, both of which are undesirable outcomes.
• These showed that unless the public health system can compete with the private in utilising funds from such insurance schemes, medical care will remain elusive for those who need it most.
•  Both RSBY and Aarogyasri are cashless hospitalisation schemes.
•  Both benefited people living below the poverty line, over-reliance on private hospitals and poor monitoring watered down their impact.
• Scheduled Tribe and rural households typically missed out, while richer quintiles of the population benefited.