India spends about 6% of GDP on health expenditure. Private health care expenditure is 75% or 4.25% of GDP and most of the rest (1.75%) is government funding. At present, the insurance coverage is negligible. Most of the public funding is for preventive, promotive and primary care programmes while private expenditure is largely for
curative care.
What does this mean in a country where at least 26 per cent of the population are still fighting for subsistence (below the poverty line)? Poverty and ill-health go hand-in-hand, and limited income means a limited capacity for health spending. For the poor, therefore, health care is often the last priority, affordable only if there is
money left over after paying for more immediate needs such as food. In such a situation, what is the government’s responsibility in providing health services for the people?
Indian health financing scene raises number of challenges, which are:
1) Increasing health care costs.
2) only 17% of all health expenditure in the country is borne by the state, and 82% comes as ‘out of pocket payments’ by the people
3)High financial burden on poor eroding their incomes.
4)Increasing burden of new diseases and health risks.
5) Neglect of preventive and primary care and public health functions due to under funding of the government health care.
6)More than one-third of married Indian women have chronic energy deficiency; more than half of them are anaemic.
7)Forty-five per cent of children under three are severely and chronically malnourished..
8)Only 42 per cent of children between the age of 12 and 24 months have completed their immunisation schedule; a massive 14.4 per cent have not received a single vaccine
9)In 2001, people continue to die for the same reasons they did when India became independent in 1947: infectious diseases.
10)As the entire Indian population ages, many more people are being struck down by non-infectious ailments. Some people believe that cancers, diabetes and heart disease will soon overtake infectious diseases as the number one killer.
11) last and the most important point Studies of household expenditure have shown that health care can use up to 40 per cent of a poor family’s budget. Even using public services costs money: fifty percent of the patients in Mumbai’s public hospitals spend more every day than the daily income of their entire household. In private hospitals, average costs for medicines, doctors’ and hospital fees can amount to twice a family’s monthly income. No wonder health care is becoming the second most common cause of debt in an indian family .
Health insurance in india
Health insurance as it is different from other segments of insurance business is more complex because of serious conflicts arising out of
adverse selection, moral hazard, and information gap problems. ,
The government insurance companies started first health insurance in 1986, under the name mediclaim; thereafter Mediclaim has been revised to make it attractive product. Mediclaim is a reimbursement base insurance for hospitalization. It does not cover outpatient treatments. First there is used to be category-wise ceilings on items
such as medicine, room charges, operation charges etc. and later when the policies were revised these ceilings were removed and total reimbursements were allowed with in the limit of the policy amount (15000 to 500000).
Health for All
The number of people covered by health insurance of non-life insurance companies is 10.8 million; health insurance by life insurance companies is 0.23 million. This implies that a very small percentage of the population – around 1 percent – is covered by commercial health insurance offered by public sector and private sector insurance companies
Health for All is still a distant dream in India, with a large proportion of the population still unable to access quality health care. Evidence abounds on the inability of the health system to give affordable, accessible, available and quality care to those who need it the most (World Bank 2001). The Tenth Five–year Plan document admits, “In all states, patients incur out-of–pocket expenses to meet the health care cost in public and privately-funded hospitals.…there are massive differences in private spending on health care services in public and private facilities between states….the high and low spending in private and public sector do not always go hand in hand with each other… the poorer segments of population have less access to both public and private sector curative services than the better off sections
Clearly, high out-of-pocket burden of health care continues to be a major issue, and injects further inequities into a system already plagued by access and quality concerns, which impact differentially on the population. In this scenario, how does one hope to achieve the “Health for All” target? While it would be difficult to achieve this target in a very short time, one way of making some progress towards it would be to find ways of extending health coverage to the population
One of the main expectations of the opening of the insurance sector in India was that health insurance could grow and become a viable option for a majority of Indians. However, this has not happened
the private sector will target only those who can afford its premiums. Private insurance companies are unlikely to provide coverage to thepoor in the urban areas, who need it the most .as the poorer segments of urban population have less access private sector curative services than the better off sections.
This in turn raises the following question: how can India achieve the goal of adequate health coverage for its urban poor population?
one way of achieving greater coverage is to use the as-yet untapped potential that exists in the voluntary (commercial) health insurance sector. In particular, it may be necessary to build and promote productive partnerships among different stakeholders involved in the health insurance sector, who are currently by and large working on their own.
To exploit this huge untapped potential Aje consultants call for productive partnerships with community based organization.
AJE Consultants Pvt Ltd
AKHILESH MAHESHWARI
9322286887
ajeconsultants@gmail.com
Health care Solutions for all