Insurance coverage

Health insurance coverage and its policy in India

Lately, the Indian government has tried various health insurance schemes to meet the needs of the marginalized sections of society, but not all of them in the direction of universal health coverage for the bulk of the citizens. There is an urgent need to address the issues of the masses in India on health and welfare. To solve this problem, the government adopted the principle of providing the services in the form of health insurance and the provision of care in different health centers.

Although health insurance allows some citizens to have access to health centers, especially in the private sector, it solves a tiny part of the problems. Many illnesses are not covered or it is difficult to access health care in remote centres. Mere provision of health insurance would not help solve the problems, but creating hard and soft infrastructure in the health sector would eliminate emerging diseases.

Building capacity in the health sector as well as upgrading infrastructure in public hospitals and facilitating private sector healthcare could help resolve the beleaguered healthcare system in India. The recent shortages of doctors and Indians going abroad to study medicine is one of the burning examples of government’s half-hearted manpower planning with its now disbanded incapable wings like the Medical Council of India (MCI).

Some of the government health insurance schemes help solve the problem to some extent. Maximum coverage of Rs 30,000/family and Rs 5,00,000/family under Rashtriya Swasthya Bima Yojana, Pradhan Mantri Jan Aarogya Yojana respectively was very popular in India.

According to the National Health Agency, 10.74 million poor rural families as well as some professional categories of urban working families were registered in the PMJAY according to the 2011 socio-economic caste census. There are up to more than 33 health insurance plans of different coverage amounts per family by state governments to meet the health insurance population. However, these diets do not help much in achieving healthy health care.

All of the state-level regimes, except a few, were strongly politically motivated to garner votes in a vote-banking policy county. The shortcomings of the plan reported by various independent studies are unavailability of an adequate bed, low amount of coverage, major procedures not covered, administrative delays, reluctance to be incorporated into plans by hospitals, low beneficiary ratings, lack of government bill clearance, red tape and many other operationalization issues. The federal structure of the Indian government often clashes with the provincial structure when it comes to insurance. Therefore, the politics of the country becomes an obstacle in the process of implementing health insurance to usher in good health among the citizens.