Introduction
5
stakeholders. In short, similar to health insurance everywhere, all schemes examined here are works-in-progress. GSHISs are not a panacea for all the problems facing the Indian health sector. However, they are a new component in health financing that has the potential to contribute to more efficient, affordable, and better quality care and, ultimately, to spearhead reform. How well these schemes become integrated into and supportive of other components of the finance and delivery system will determine their long-term sustainability. Further, international experience has shown that no matter how successful these fledgling GSHISs are during their initial years, early success is no guarantee of future success. This book is the first comprehensive review of all the major publicly funded health insurance schemes in India. It responds to a request from the Ministry of Health and Family Welfare (MOHFW) received by the World Bank in June 2010 to assess GSHISs in terms of their organizational design features, spending, impacts, challenges, and potential to contribute to the achievement of universal coverage. The collaborating partners for the field research, the Public Health Foundation of India and Access Health International, also received similar requests from the Planning Commission, the government of India, and the state government of Andhra Pradesh (AP), respectively. The rest of this chapter outlines the analytical framework and methods used to assess the schemes and construct the case studies. It also contains a summary matrix depicting the salient features of each scheme. Chapter 2 briefly outlines the current configuration of health finance and delivery in India and examines the context in which the schemes developed. It distills the design linkages among the schemes and the ways certain trends and innovations have disseminated among the schemes over time. Chapter 3 synthesizes organizational, operational, and design issues emerging from the case studies. Chapter 4 presents recommendations for strengthening the design and operational features of the schemes that can be implemented in the short term. Chapter 5 proposes options for the medium-term expansion of health insurance and linking demandand supply-side financing and delivery arrangements. This chapter also includes an agenda for future research. Appendixes A through I contain detailed case studies of nine GSHISs. For these schemes, sufficient information was collected to produce case studies.3 Appendix J includes the instruments applied to collect information and data for the cases. Appendix K contains a glossary of terms used in this book.