Health insurance

HEALTH INSURANCE AND SCHEMES

1. HEALTH INSURANCE PRAMOD KUMAR

2. HEALTH Health is defined as "a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity." 

3. HEALTH INSURANCE Health insurance is a type of insurance coverage that covers the cost of an insured individual's medical and surgical expenses.

4. NEED

5. Health insurance in India is very limited covering about 13% of the total population. The existing schemes can be categorized as : 1. Voluntary health insurance schemes or private for profit schemes: In the public sector, the general insurance corporation (GIC) and its four subsidiary companies (National insurance, corporation, new India assurance company, oriental insurance company and united insurance company) and life insurance corporation (LIC) of India provide voluntary insurance schemes. Currently, a few companies such as bajaj alliance, ICICI, Royal sundaram , and cholamandalam among others are offering health insurance schemes.

6. 2. Employer-based schemes: The railway, defense and security forces, plantation sector and mining sector medical services and / or benefits to its own employees.

7. 3. Insurance offered by NGOs/ community based health insurance : Some examples of community based health insurance schemes are: self employed women’s association (SEWA) AMUL Dairy cooperatives in Gujrat , The mallur milk cooperative in Karnataka Action for community organization, rehabilitation and development (ACCORD) nilgiris Kadamalai kalanjia vattara sangam (KKVS) Madurai Voluntary health agencies (VHS) Chennai Raigarh ambikapur health association (RAHA) Chhatisgarh

8. 4. Mandatory health insurance schemes or government run scheme: The government- run schemes includes the central govt. health schemes (CGHS) and the employees state insurance schemes (ESIS).

9. CENTRAL GOVERNMENT HEALTH SCHEME (CGHS)   The Central Government Health Scheme (CGHS) was started under the Indian Ministry of Health and Family Welfare in 1954 with the objective of providing comprehensive medical care facilities to Central Government employees, pensioners and their dependents residing in CGHS covered cities.

10. The scheme was initially started in Delhi in 1954. Subsequently CGHS Services were extended to the following 17 cities: Allahabad, Ahmedabad, Bangalore, Mumbai, Kolkata, Hyderabad, Jaipur, Jabalpur, Lucknow , Chennai, West Bengal, Nagpur, Patna, Pune, Kanpur, Thiruvananthapuram and Guwahati.

11. The Central Govt. Health Scheme is applicable to the following categories of people residing in CGHS covered cities : All Central Govt. Servants paid from Civil Estimates (other than those employed in Railway Services and those employed under Delhi Administration except members of Delhi Police Force).   Pensioners drawing pension from Civil Estimates and their family members (Pensioner residing in non- CGHS areas also may obtain CGHS Card from nearest CGHS covered City)

12. The medical facilities are provided through Wellness Centers (previously referred to as CGHS Dispensaries) /polyclinics under Allopathic, Ayurveda, Yoga, Unani , Siddha and Homeopathic systems of medicines. v 254 allopathic dispensaries, 19 polyclinics.78 Ayush dispensary/ units, 3 Yoga Centers, 65 Laboratories v 17 Dental Units.

13. THE MAIN COMPONENTS OF THE SCHEME The dispensary services including domiciliary care. M.C.H. Services. Specialist’s consultation facilities both at dispensary, polyclinic and hospital v level including X-Ray, ECG and Laboratory Examinations. Hospitalization. Organization for the purchase, storage, distribution and supply of medicines v and other requirements. Health Education to beneficiaries.

14. RASHTRIYA SWASTHAYA BIMA YOJNA (RSBY ) Central govt. health insurance scheme for the Below Poverty Line (BPL) families in the unorganized sector. It was formally launched on October 1, 2007. The majority of the financing, about 75 % is provided by govt. of India, while remainder is paid by the state govt.(25%). The registration fees of Rs. 30 would be collected from the beefier by the insurance company and adjusted against the payment of premium to be made to the insurance company by the state govt.

15. BENEFITS :

16. EXCLUSIONS

17. CHALLENGES : Limited Influence over healthcare delivery mechanism High claim ratio – Around 140% Low level of consumer Awareness Limited product development Limited knowledge for staff/Agents Pricing demands from Insurance companies

18. Lack of proper communication between TPAs and Hospitals Delay in Settlement of Claims Lack of Training support from Insurers as well as TPAs Preexisting diseases disputes between consumer and TPAs Different Insurance Companies – different policies, terms etc

19. RESEARCH ARTICLE : The Effect of Health Insurance Coverage on the Use of Medical Services Michael Anderson, Carlos Dobkin , Tal Gross NBER Working Paper No. 15823 Issued in March 2010 Substantial uncertainty exists regarding the causal effect of health insurance on the utilization of care. Most studies cannot determine whether the large differences in healthcare utilization between the insured and the uninsured are due to insurance status or to other unobserved differences between the two groups. In this paper, we exploit a sharp change in insurance coverage rates that results from young adults "aging out" of their parents' insurance plans to estimate the effect of insurance coverage on the utilization of emergency department (ED) and inpatient services.

20. Using the National Health Interview Survey (NHIS) and a census of emergency department records and hospital discharge records from seven states, we find that aging out results in an abrupt 5 to 8 percentage point reduction in the probability of having health insurance. We find that not having insurance leads to a 40 percent reduction in ED visits and a 61 percent reduction in inpatient hospital admissions. The drop in ED visits and inpatient admissions is due entirely to reductions in the care provided by privately owned hospitals, with particularly large reductions at for profit hospitals. The results imply that expanding health insurance coverage would result in a substantial increase in care provided to currently uninsured individuals.