Why does India have Low Health Insurance Coverage?

The global study carried out on Sustainable Development Goals (SDG) and published in The Lancet indicates that India ranks 143 out of 188 countries in health performance. This ranking was based on different universal goals, targets and indicators defined by United Nations. Earlier in 2000, the World Health Organization did a ranking of the 191 member nations and India ranked 112/191 in that.

These international rankings indicate the poor healthiness care system of India in spite of its growth and development in other sectors. Several factors contribute to the underdeveloped health care system and facilities in India that needs a serious approach for much needed improvement. Less than 20% of India’s population is having some form of fitness insurance. Out of this population that are covered by some insurance, close to 70% people are covered under public insurance companies, these include: National, New India, United India and Oriental. For the rest, there are private sector players. Apollo Munich, Star, Cigna TTK, Future, Bajaj, ICICI Lombard are the major players in private sector.

Besides the defined health insurance, about another fifteen and half crore people have been covered by three fitness schemes that are funded by Central Government. These are: Employees’ State Insurance (ESI) Scheme, Central Government fitness Scheme and Rashtriya Swastha Bima Yojana.

Reasons for low Health Insurance coverage

There are several reasons why so less people are covered under health insurance. Those include:

• Low Public health Spending – According to the report published by World Bank, in 2014 only 4.7% of India’s Gross Domestic product wasused for physical condition expenditure. This is one of the lowest in India comparing to most of the neighbouring nations. Bad governance and underfunding is responsible for channelizing the funds towards physical condition sector. This prevents majority of people of India who are financially challenged and/or below poverty line to access any sort of healthiness insurance

• The concept of vigour Insurance is relatively new and unexplored by the majority. Only the employers from organised sectors provide the benefit of insurance to their employees. Individual Insurance is still far from a widespread reach

• Rural penetration of fitness insurance is very low due to lack of awareness of people, limited Government initiative in public fitness sector, the practice of using traditional methods of treatment among people, low proximity to the hospitals and lack of proper doctors in the rural fitness centres and hospitals. All these prevent the implementation of Health assurance scheme in the unorganized sectors of rural and semi-urban India

• Alternate medicines are not covered by insurance — Due to lack of proper health care system by Government, the private sector is dominant in providing wellbeing care. And this is highly expensive. So poor people depend on low cost traditional medicines like Homeopathic, Ayurvedaand Unani products. These being alternate medication and the mode of treatment, do not fit into the specification of Insurance companies

• Many patients get treatment from private practitioners, Family physicians and individual doctors who are not associated with commercial hospitals. In such cases the cost of treatment are not exorbitant and they do not go for the complicacy of health insurance as well as the payment for physical condition insurance coverage

• Some disadvantage of Mediclaim policy is that though it covers hospitalization, but Out Patient treatment is not covered. Many a times the cost of visiting Outpatient physicians is unaffordable for economically backward community. This shortfall discourages people to go for paying the premium for health insurance coverage.

Measures to Improve Health Insurance Coverage in India

India’s Health sector requires an urgent make over with better and widespread availability of health facilities across India. Some measures could be :

• A long term vision for initiating and implementing an infrastructural change so that more and more people could be broughtunder health insurance schemes and this must be taken as priority by Government along with private players

• The fitness care requirement is different for the various socio-economic groups and the need-based customization is important to provide a high quality fitness service. The rural sector needs to be included under health insurance scheme and this is possible by understanding the consumer preferences, proper pricing of the insurance products to make it more affordable and attractive to this sector

• Building awareness among mass about the benefits of health cover coverage combined with affordable options offered, will encourage the common mass to join the program