Bring all patients under insurance cover, suggests World Bank study

Noting that half of the population of the country would be under some form of health insurance in the next three years, a World Bank study suggested that both inpatients and outpatients should be brought under insurance schemes to make them attractive.

Commissioned by the Union Health Ministry, the study said that by 2015, more than 630 million Indians would be under some type of health insurance of government or private companies and suggested that the government needs to plug several loopholes in the state-sponsored schemes.

It said the government-sponsored schemes were not comprehensive as they focus on inpatient care, primarily surgery and maternity care.

“The study recommends increasing health insurance coverage for both outpatient and inpatient care to include poor and near poor patients and hike purchasing power for insurance schemes like centrally-funded Rashtriya Swasthya Bima Yojna ( RSBY),” said Somil Nagpal, the Bank's health specialist who, along with the Bank's lead health specialist Gerard La Forgia, wrote the report released here on Thursday.

“A comprehensive service package for the below poverty line (BPL) population would have financial components from the Central and state governments. While the Centre will finance the ambulatory package and the secondary and maternity care, the states can provide top-off package for tertiary care,” Nagpal said.

Asked about the ways to improve the RSBY scheme, Keshav Desiraju, special secretary in the Union Health Ministry, said more intensive regulation was needed to expand its benefits to a wider section of the public.

The RSBY and other government-sponsored schemes have come under criticism for unnecessary hospital stay, medication and surgery as some doctors and hospital administration had allegedly tried to take advantage of the insurance.

Moreover, evidence was emerging of cases of induced demand, illegitimate charges and frauds in government-sponsored schemes such as false claims, ghost patients and claim bundling, the study said.

However, the report said the growth in the government-sponsored schemes in India was unparallelled.

Over 300 million people or more than 25 per cent of India's population gained access to some form of health insurance by 2010, up from 55 million in 2003-04. More than 180 million of these were BPL people.

It said that out of the 630 million people who would come under health insurance by the year 2015, 528 528 million would be covered under the government schemes while 90 million will be insured by commercial insurers. “Effective steps need to be taken to make the health insurance more robust and attractive to consumers,” Desiraju said.