Government funded health insurance scheme has little impact, finds study

NEW DELHI: The government run health insurance scheme in the country has done little to help those insured as they still need to incur out-of-pocket expenditure during hospitalisation, a group of public health researchers from India and South Africa have found.

The study that used Chhattisgarh, which has the maximum number of beneficiaries under India’s national health insurance scheme, as test case found that over 95 percent of those covered could not fully avail cashless hospitalisation in private hospitals.

The researchers also found that about 66 per cent of those going to government hospitals also needed to spend from their pockets to meet hospitalisation charges.

The detailed study carried out on the impact of Rashtriya Swasthya Bima Yojana, launched in 2008, was carried by researchers associated with the Public Health Resource Network, Raipur, Tata Institute of Social Sciences, Mumbai and the University of the Western  Cape, Belville, South Africa.

The scheme, launched in 2008, gives coverage of Rs 30,000 to those enrolled and Chhattisgarh has one of the highest enrolment rates among 15 states which have opted to implement it.

“One of the most eye catching finding of the study is that more than one third of the families incurred catastrophic health expenditure due to hospitalisation and despite insurance coverage, people have to incur out of pocket expenditure for hospitalisation,” Sulakshna Nandi, one of the researchers told this newspaper.

“The public sector is much cheaper and a lower percentage of people have to pay from their pockets when compared to the private sector,” she added. “It is also serving the more vulnerable groups- women, rural population and tribals and shows that the public sector is still important and relevant for people”.

Nandi also said that out of pocket expenditure is also to extra payments that private hospitals take from patients even after using the health insurance.

“The government is unable to regulate it despite having a contract with the empanelled hospitals. If it tries to crack down on the private hospitals, they are able to counter it with their clout,” she observed.

Other public health activists were of the opinion that the reason why state funded health insurance scheme is not picking up could be lack of proper provisioning.

“RSBY and few other health procedure aids given by some state governments are often inadequate as they have not been planned properly from the viewpoint of a patient,” said Oommen John, a senior research fellow and internal medicine specialist at The George Institute For Global Health, a health research institution based in New Delhi.

“When somebody, for example, is admitted for a surgery—while the procedure itself might be free under the scheme—the drugs and other  consumables are often required to be bought by patient’s family—all of that adds to the overall cost,” John said.

“One of the reasons why the government’s thrust on institutional delivery has worked in the country is because the programme is implemented well and beneficiaries are also incentivised. A similar approach should be adopted towards state run health insurance scheme,” he added.