India does not have adequate health insurance cover. Today around 20 % of the population is covered by some kind of health insurance. This includes the insurance provided by the government through the Rashtriya Swashtya Bima Yojana. Broken down by the Urban and Rural segments, that amount to 12 % of the Urban population and around 13% of the rural population have insurance. This is data from the latest National Sample Survey released by the government.
The surprising finding is that the richer households have more access and awareness of insurance as compared to the poorer sections of the society. So those who desperately need it and run the risk of losing all their savings due to medical conditions don’t have insurance.
Now I don’t think health insurance is the silver bullet to our healthcare problems. In countries like the US where Health insurance is the system, the cost of healthcare has just gone up. That is why the health insurance provided by the government is the key and is somewhat like the NHS in the UK.
But even awareness and access is low then it defeats the purpose. So what seems to be the challenge ? I think there are two basic issues.
Issue number 1 is awareness.
India has many private health insurance companies providing access to care. I have a private health insurance policy from Max Bupa. I have been paying premiums for last 5 years, but have not availed any benefit, and hopefully will not avail the insurance in near future. Some of my relatives never understood the concept of paying premiums without returns. Maybe that is the first problem with health insurance. We are no used to the concept of LIC that we expect health insurance companies to give returns.
Second issue is access.
Now most people don’t have access to private insurance. But they should have access to the government health insurance scheme through the Rashtriya Swashtya Bima Yojana. Now in case of private health insurance, you have technology enabled platforms. Recently I came across the private managed healthcare provider, Medi Assist, who have handled more a 20,00,000 claims this year. Now expectant mothers and families can plan an eCashlesshospitalization from the comfort of their home using their MediBuddy mobile app. With eCashless, the couple gets full visibility into the estimated cost of care, the value of co-payment if applicable and the out of pocket expenses they should plan as well.
“Maternity is often the single largest contributor, accounting for as much as 30%, of health benefit spend among most of the corporate group medical policies that we administer. It is our endeavour to work with our insurer partners and help our corporate customers, not necessarily reduce this spend, but extract greater benefit from it, and importantly reduce out of pocket expense for the family,” says Satish Gidugu, COO, Medi Assist.
Now what about the access for non corporate citizens. They are either Digitally savvy and access through their smart phones and computers. But if they are not they they don’t have access to all these wonderful insurance schemes that the government has created for this very purpose.
Having said that the Rashtriya Swasthya Bima Yojana is definitely a step in the direct direction as far as the intention is concerned. Floated in 2008, the policy aims to cover all people below poverty line initially but now has been expanded to cover workers in the unorganized sector such as street hawkers, beedi workers and people under NREGA. The intention is to allow the insured family to choose the private or government healthcare facility of their choice. All they have to pay is Rs 30 as the registration fees and they are entitled to cashless hospitalization of up to Rs 30,000 and transport expenses of Rs 100 per hospitalization up to a maximum of Rs 1,000 for the year.
The objective is to
1.To provide financial protection against catastrophic health costs by reducing out
2.To improve access to quality health care for below poverty line households of pocket expenditure for hospitalization and other vulnerable groups in the unorganized sector
The scheme is applicable up to 5 members of the family and the plan is to cover 70 million households as part of the current plan 2012-2017. For more on the scheme please read here.
So we need health insurance to work but access to these schemes and their awareness remains a challenge. While our upper strata have access to finances and in most cases insurance. It is the middle and the lower strata that struggle with it. I know a lot is being done to help the situation but then why is there a gap ? Are we doing enough ? Let me know your thoughts.