Preface
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the existing state-sponsored top-off and tertiary-care schemes to guide the design of the benefits package. (4) State-financed “contributory” point of service package for the vulnerable non-BPL population. This recommendation involves offering a “contributory” point of service scheme for the vulnerable non-BPL group. This group may not be the poorest in the population, but it is financially vulnerable to health shocks and generally seeks care from private providers, paying out-of-pocket for nearly all services. Several states already classify this “vulnerable” population as poor, but poverty data suggest that they do have some capacity to pay for care. Ideally, this scheme’s benefits can consist of an integrated offering of the aforementioned standard (secondary and maternity), ambulatory care, and “top-off” (tertiary care) packages. The administrative costs of collecting from the informal sector are expected to be high, and the collection procedure, complex. The collection procedure is also likely to result in incomplete uptake and adverse selection. Therefore, no upfront collection of contributions from this group is recommended. Potential beneficiaries would be enrolled free of cost (or automatically) as in the case of the BPL population. They would “contribute” only when seeking care, by making copayments for the claim costs at the point of service, namely, the hospital. Depending on their fiscal capacity, states could consider a 30 to 70 percent subsidy of the package costs for this vulnerable group. Because this state subsidy is applied to the already negotiated (and discounted) package rates, it would effectively lower out-of-pocket spending to a small fraction of the fee-for-service market prices which the intended beneficiaries would incur without it. This would be a strong incentive to enroll. The feasibility of this scheme, however, will depend on improvements in targeting and separation of BPL from the vulnerable non-BPL group. What would be the institutional arrangements for the proposed schemes? GOI would establish a governance agency to support all GSHISs. This autonomous national umbrella agency would coordinate, monitor, evaluate, and provide technical support to all government-sponsored schemes, including the preparation of guidelines, policies, statutes, information technology systems, and operating instructions and manuals. Each state would administer the multiple components of the proposed coverage as part of an integrated, state-executed insurance system, including the pooling of risks, purchasing of services, and direct monitoring of providers and beneficiaries. Thus, services for all schemes would be bought from a