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Government-Sponsored Health Insurance in India
Figure 2.4 India: A Genealogy of Government-Sponsored Health Insurance Schemes ESIS (1948) and CGHS (1954)
private insurers—Mediclaim (1986)
UHIS (2003)
RSBY (2008)
Yeshasvini (2003)
Aarogyasri (2007)
Kalaignar (2009)
Vajpayee Arogyashri (2010)
RSBY plus (2010) ASBY (2010–11) Source: Authors.
voluntarily purchased from any state-owned insurer at a heavily subsidized price (e.g., Rs. 165, less than US$4 a year). Despite its name, the scheme remained far from “universal” and covered only 3.7 million lives by 2008–09. Another scheme launched in the same year was Yeshasvini, a contributory scheme introduced by the Department of Cooperation in Karnataka for the members of rural cooperative societies in that state. Both schemes provided valuable lessons and possessed a number of common structural features that were adopted by the new generation of GSHISs. Features introduced by at least one of these schemes include: premium partially or largely subsidized by government on the demand side; cashless inpatient coverage; service provision by “networked” public and private hospitals; provider payment through prospective, case-based “package” rates; a bottom-up coverage design consisting of targeting the informal and BPL populations; and use of health insurance companies or third-party administrators as intermediaries for risk underwriting or administrative functions or both.17 Benefits design of UHIS and Yeshasvini was also modeled on standardized insurance products sold in the private market since the mid-1980s.