Introduction
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significant changes in traditional government health financing and delivery arrangements in India. They have established a demand-side mechanism that mobilizes and channels additional public financing to health, introduced an explicit benefits package, pioneered cashless care (e.g., there are no point of service payments or other forms of cost sharing required from beneficiaries and the hospital charges are directly settled by the schemes with their network hospitals), fostered public private partnerships (with insurers and providers), and in principle stimulated competition among insurers (for government contracts) and providers (for beneficiaries, when ill). Prior to the appearance of these schemes, nearly all public financing was directed to government-owned and -operated service providers to support an implicit but irregularly (at best) delivered benefits package. Although services are nominally free in most cases, users faced significant costs for unavailable drugs and consumables, transportation, diagnostics, and other services as well as informal payments. Moreover, the GOI has yet to deliver on pledges for significant increases in public financing for health, at least through the public delivery system. However, recent pronouncements suggest that government may double public spending on health in the 12th Five Year Plan, 2012–17 (Planning Commission 2011). Based on a systematic review of nine GSHISs, including older social health insurance schemes (SHIs), the objective of this book is to assess their practices and performance to enable policy makers to gain insight into emerging issues requiring their attention if India is to achieve universal health coverage. The focus is on two lines of inquiry. The first involves institutional and “operational” opportunities and challenges regarding their design features, governance arrangements, financial flows, cost-containment mechanisms, underlying stakeholder incentives, information asymmetries, and potential for impact on financial protection and on access to care and use by targeted beneficiaries. The second entails “big picture” questions on the future configuration of India’s health financing and delivery systems that have surfaced, due in part to the appearance of a new wave of GSHISs after 2007. How these schemes will interact with and affect the wider health financing and delivery system is a major underlying issue facing Indian policy makers. Will they contribute to integration or will they lead to greater fragmentation? Will they contribute to improving health sector efficiency and quality or will they lead to a steep escalation in the cost of health care? Will explicit entitlements be expanded, and if so, does government have the capacity to enforce the provision of the benefits