Health study flags insurance holes -GS Mudur

-The Telegraph

Hospitalisation cover does not protect families from catastrophic expenses

A three-state study has found that India’s government-funded or private health insurance schemes that pay for hospitalisation have not adequately protected households from catastrophic health expenditures and rekindled the debate on how to achieve universal health care.

The study that examined sample households in Gujarat, Haryana and Uttar Pradesh found 28 per cent of insured households and 26 per cent of uninsured households faced catastrophic health expenditure that significantly altered their expenses on essential services.

“Health insurance in its present form does not seem to provide requisite improvement in access to (health) care or financial risk protection,” health economists who analysed health-care spending by 12,134 households in the three states said in their report.

Their findings, published this week in the journal PLOS One, echo long-standing concerns among sections of health experts that insurance schemes that only cover hospitalisation costs continue to expose households to significant financial risk.

The Narendra Modi government had last year launched the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) for 10 crore poor households — or 40 per cent of the population — that pays up to Rs 5 lakh per year per household for hospitalisation. The Centre and states pay the scheme’s premium on a 60:40 ratio.

The three-state study probed health-care spending by households covered by earlier government-funded schemes — such as the Centre’s Rashtriya Swasthya Bima Yojana (RSBY) that paid up to Rs 30,000 per year — and private health insurance.

The households covered by the Centre’s Rashtriya Swasthya Bima Yojana had the highest proportional prevalence (39 per cent) of catastrophic health expenditure followed by households with private insurance (23 per cent) and state insurance schemes (21 per cent).

The study found that average out-of-pocket or personal expenditure for in-patient care among the insured was about Rs 32,000 and about Rs 24,000 for the uninsured. The average out-of-pocket expenditure was highest (Rs 73,000) for people enrolled under private health insurance schemes and lowest (Rs 15,000) for people under the RSBY.

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The Telegraph, 11 February, 2019,

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