Health Assurance Mission (NHAM) is likely to be launched in coming days. This will bring much needed promise to the evolution of health insurance model in India. To be rolled out in phases, it may take a decade before the scheme can be actually offered to everyone.
National Health Assurance Mission (NHAM) is one example of Government-sponsored Health Insurance schemes (GSHISs). The Congress regimen in 2008 had launched an ambitious Rastriya Swasthya Bima Yojna (RSBY). It focuses on providing inpatient coverage to families living Below Poverty Line (BPL). With a mere registration fee of Rs. 30, RSBY provides cash-less health insurance to BPL families up to Rs. 30,000. The entire premium is paid by the state (25%) and central (75%) governments. With the introduction of NHAM, RSBY will be gradually merged into NHAM.
Government-sponsored Health Insurance schemes (GSHISs) are not new to India, but surely the evolution has been slow. Employees’ State Insurance Scheme (ESIS), Central Government Health Scheme (CGHS) schemes are in vogue since decades. ‘Mediclaim’ was a private voluntary health scheme launched in 1986 by government insurance companies. In the last decade, a few states have successfully launched health insurance schemes: AarogyaSri (Andhra Pradesh), Vajpayee Arogyashri (Karnatka), the Chief Minister Comprehensive Health Insurance (Tamil Nadu) and RSBY Plus (Himachal Pradesh). The most crucial advantage of government sponsored health schemes is that they are primarily targeted at poorer people, thus enabling a bottom up approach for health for all.
Compared to USA where 75 % of people have health insurance, the most common mode of payment for medical services in India is still ‘out of pocket’. Thus, there is ample scope for health insurance in India. With government’s push for universal health coverage, this market is likely to grow in coming years. Government sponsored Health insurance is likely to be the dominant theme, but private insurance companies can also play a crucial role. Not only they will bring in the much needed investment, their entry will bring better practices, competition and a global insight. Health insurance is currently limited to indoor treatment. There is a need of coverage being extended to outpatient treatment and procedures too.
Health insurance is not without challenges in India. In our country, there is already a high level of medical malpractice. The unfettered continuation of such unethical practices may bleed health insurance schemes. Then there is lack of standardization of medical treatment regimens and practices in India, creating challenges for the insurance companies when it comes to reimbursements.
Medicine cannot just continue as a private matter, it must evolve into a social institution wherein it can serve the basic needs of the society. Universal health assurance hopefully will accelerate the process for India in the direction.