Govt sponsored schemes: Meant for poor, but beyond their reach?

Prof Dayashankar Maurya, highlighted about the current spendings of Government Sponsored Health Insurance Schemes (GSHIS) which is around Rs 2500 cr on various national and state-run schemes. These schemes have converted healthcare need into healthcare demand by bringing millions of consumers into the formal healthcare market which were beyond reach. The schemes have got the attention of healthcare sector and have provided additional resources.

Out of the total health insurance coverage, which is around 15-18 per cent, GSHIS holds 75 per cent of this share, but as for the premiums they collect a total of 12 per cent. He mentioned the status and the evolution of the government health insurance schemes. He pointed that major developments in the insurance industry have taken place in the last decade. He elaborated on different design modules available for GSHIS including schemes for various states.

Another focus point was, “Are these schemes reaching the intended beneficiaries.” He explains that the lists include educated and politically connected people who are not below the poverty line whereas the ones who are under BPL are not included. He also discussed about the schemes not meeting the health needs of the beneficiaries. Further, he opined that though there is an increase in utilisation and patient satisfaction is high, yet there has been no reduction in the out of pocket expenses. Also, the impact on the catastrophic expenditure is minimal.

The reason behind this are issues in institutional design, minimal monitoring and lack of managerial interventions. He suggests a few measures to improve including improving design by having an institutional structure and capabilities; improvising the system and measuring progress;  and reducing fragmentation.