Somil Nagpal

Government-sponsored health insurance in India : are you covered?

Since independence, India has struggled to provide its people with universal health coverage. Whether defined in terms of financial protection or access to and effective use of health care, the majority of Indians remain irregularly and incompletely covered. Finally, and most recently, a new generation of Government-Sponsored Health Insurance Schemes (GSHISs) has emerged to provide the poor with financial coverage. Briefly, the main objective of these new GSHISs was to offer financial protection against catastrophic health shocks, defined in terms of an inpatient stay. Between 2007 and 2010, six major schemes have emerged, including one sponsored by the Government of India (GOI) and five state-sponsored schemes. This new wave of schemes provides fully subsidized coverage for a limited package of secondary or tertiary inpatient care, targeting below poverty populations. Similar to the private voluntary insurance products in the country, ambulatory services including drugs are not covered except as part of an episode of illness requiring an inpatient stay. The schemes have organized hospital networks consisting of public and private facilities, and most care funded by these schemes is provided in private hospitals. Ostensibly, the objective of any health insurance scheme is to increase access, utilization, and financial protection, and ultimately improve health status. Due to lack of evaluations and analyses of household data, the authors of this book do not examine the impact of health insurance in terms of these objectives. This book is not meant to highlight problems of the GSHISs, but rather to raise potential challenges and emerging issues that should be addressed to ensure the long-term viability of these schemes and secure their place within the health finance and delivery system.

Creating Evidence for Better Health Financing Decisions: A Strategic Guide for the Institutionalization of National Health Accounts

One of the key constraints to improving health outcomes in the developing world relates to equitable and efficient health financing. In most developing countries, a large portion of health expenditure is private and out-of-pocket (Gottret and Schieber 2006). This book represents a synthesis of lessons learned from country experiences and is intended to serve as a strategic guide to countries as they design and implement their policy to develop nationally relevant and internationally comparable data, collected in a routine and cost-effective manner. National Health Accounts (NHA) substantially contribute to the effort of improving health financing policy at global and country levels and offer a globally recognized framework for collecting, compiling, and analyzing data on health expenditures to and within the health system. As part of this effort, a framework has emerged that presents NHA activities as a cycle of activities with a clear purpose to serve policy makers, extending beyond the production of data: it involves the broad dissemination of that data and their translation into insightful analysis that can form an evidence base for effective policy making, underpinned by the nature of a given countrys governance structure, human resources, and financing abilities. This book makes a distinct contribution in the way it addresses each step in the cycle of activities, assisting countries take greater ownership of the process of producing evidence and to make greater use of that evidence for better health financing decisions.