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640 Cardio Diabetes Medicine 2017

Health Insurance

A Comprehensive Study

Dr. S. Prakash, MS,FRCS(Glasg), FAIS
Chief Operating Officer,
Star health and allied insurance Co.Ltd.

Health Insurance Industry in India – The Scheme is an earmarked fund set up by government
with explicit benefits in return for payment. The social
Advent health insurance includes the Central Government
The Government of India, post-independence, laid Health Scheme (CGHS) and Employees State Insur-
stress on primary health care and put in continu- ance Scheme (ESIS) . Community health insurance
[6]
ing efforts to uplift the health care system across scheme is any non-profit insurance scheme aiming
[1]
the country . India’s tryst with health insurance primarily at the informal sector and formed on the ba-
programme goes back to the late 1940’s and early sis of a collective pooling of health risks and payment
50’s when the civil servants were provided the Cen- therefore. Community Health Insurance schemes in-
tral Government Health Scheme and formal sector volve pre-payment and the pooling of resources to
workers were provided the Employees State Insur- cover the costs of health-related mishaps .
[7]
ance Scheme. These schemes were contributory but
heavily subsidized health insurance programmes . Private Health Insurance is voluntary. The insurer
[2]
As a consequence of liberalization of the economy generally collects the premium from individuals who
since the early 1990s, the government opened up the can afford to pay and then invests this to supplement
[8]
private sector including health insurance in 1999. This the insurance fund .Insurance is a pooled fund.
development threw open the possibility for higher Government Health Insurance Schemes (GHIS’s) are
income groups to access quality care from private usually for the poorest and vulnerable sections of the
[3]
tertiary care facilities . However, since 2007, India community. Under these schemes, the premium is
has witnessed a deluge of new initiatives, both by the totally subsidized by the government from tax-based
central government and a host of state governments revenues and is paid directly to the insurer. The major
also entering the GHIS’s schemes are the Universal Health Insurance
Scheme (UHIS), Rajiv Arogyashri Scheme (RAS),
bandwagon of health insurance . One of the rea-
[4]
sons for initiating such programs may be traced to Rashtriya Swasthya Bima Yojana (RSBY), Vajpayee
the commitment of the governments in India to scale Arogyasri Scheme, Karnataka and Chief Minister Ka-
up public spending in health care . India spends laignar Health Insurance Scheme, Tamil Nadu.
[2]
about 6% of GDP on health care, out of which 22 % Given that government has liberalized the insurance
of overall spending occurs in the Government sector industry, health insurance is now known to be a
while 78% of overall spending in private sector . Sunrise Industry. It had been noted that Health In-
[4]
surance, if left only to the Private Market would only
In India, the advent of Health Insurance occurred with
the launch of the Mediclaim policy in November 1986 be available to those with a considerable capability
by the General Insurance Corporation. Thereafter to pay. There is a need for alternative finances, in-
several kinds of policies have been floated contin- cluding provision for medical insurance at a much
uously in this field by both public and private health wider level. Health insurance is emerging to be an im-
insurers . The types of health insurance are as: So- portant financing tool in meeting health care needs
[5]
[9]
cial health insurance (SHI) schemes are statutory of the poor .It was found that the market trend and
programmes financed mainly through wage-based penetration level of health insurance business and
contributions and related to level of income. An SHI the premium level and index of growth of health in-

GCDC 2017