Hardly a gamechanger

Hardly a gamechanger

Context:

The National Health Protection Scheme announced in this year’s Budget has generated a lot of debate.

Why in news?

• The government has committed to “providing coverage up to Rs. 5 lakh per family per year for secondary and tertiary care hospitalisation” for 10 crore poor families, with approximately 50 crore people as beneficiaries.

Targets :

• The National Sample Survey (NSS) 71st round (2014) unit record data for “Social Consumption in India.
• Health” shows that only 11.3% of the bottom 40% (10.5% covered by government insurance) population has any insurance coverage as against 17.9% for the top 60% (14.3% covered by government insurance).
• The latest official data for 15 States show, starting from 2008, only 66% of the target below poverty line population has come under coverage of the Rashtriya Swasthya Bima Yojana (RSBY).
• The government-run health insurance programme for the poor in 2017-18, the government allocated only Rs. 1,000 crore for RSBY, covering roughly 10% of the bottom 40% of the population.

The problem in terms of the rate of hospitalisation and reimbursement of expenses

• The rate of hospitalisation for those covered under some kind of health expenditure support is higher than those without any cover, for the bottom 40% as well as the entire population.

• Reimbursement as a percentage of medical cost of hospitalisation in government schemes is abysmally low, especially for the bottom 40% of the population.
• This raises questions about the efficacy of government schemes.
• The proportion of hospitalisation cost reimbursed is much higher for insurance schemes directly bought by households than government ones.

For private players:

•    Health insurance creates a larger market for private players.