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Government-Sponsored Health Insurance in India
Most measures can be implemented over an estimated two-year period. The enabling institutional and accountability environment would also facilitate the design of a reconfigured set of schemes proposed to be implemented in a subsequent phase, which is the subject of chapter 5.
Promoting Governance and Coordination In his study of institutional governance arrangements in social insurance schemes, Savedoff (2008) defined governance as a combination of factors that influence the behaviors of an organization, particularly in terms of accountability relations (e.g., to government, members, and providers), incentives alignment, and information availability and transparency.1 Governance arrangements continue to be generally inadequate or absent in GSHISs, particularly in terms of accountabilities, incentives, and information availability. Although the same can be said of the public delivery system, the complexity of demand-side financing approaches with explicit entitlements necessitates greater attention to establishing sound institutional and governance arrangements to make schemes viable, sustainable, and high performing. The key to any good governance arrangement is to protect the schemes from political interference while making them accountable to major stakeholders such as government and beneficiaries. Leveraging the fact that the government of India (GOI) already finances the major and fastest-growing scheme, Rashtriya Swasthya Bima Yojana (RSBY), and is a major contributor to others (Central Government Health Scheme [CGHS], and to a lesser extent, Employees’ State Insurance Scheme [ESIS]), and will continue to play a major financial role in the roll out of GSHISs and any future reconfiguration thereof (chapter 5), it should establish a legally autonomous umbrella health insurance coordination agency.2 This entity would support, coordinate, monitor, and evaluate all GSHISs, including the social insurance schemes (e.g. ESIS, CGHS). This agency should also work closely with the private insurance regulatory authority, Insurance Regulatory and Development Authority (IRDA) to ensure synergistic and holistic regulation of the entire health insurance sector. The overall mission of the proposed agency would be to promote the timely access and provision of services to beneficiaries of central and state GSHISs. It would also ensure that beneficiaries receive care of acceptable quality and that schemes are operated in a transparent and