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Government-Sponsored Health Insurance in India
The operational capacities of the PVHI industry to process prior authorizations for cashless claims and the claim payment processes also grew, accounting for several million transactions annually. The information technology capabilities of insurers, TPAs, and hospitals—an essential prerequisite to the success of most new GSHISs—also witnessed consistent development across the industry. The commercial health insurance market itself has become fiercely competitive, which has also benefited the emerging GSHISs. Insurers have demonstrated their willingness to quote lower and lower prices in a bid to acquire larger volumes of business. This was reflected in the low premium bids offered by insurers for the GSHIS business (chapter 3, this volume). The low premiums facilitated the affordability of GSHISs for government, at least in the short term. However, in the long run much greater resources may be needed to sustain the schemes. Returning to the public sector, the system known as “Chief Minister’s Relief Fund” was also a precursor in the genealogy of the newer GSHISs, especially for the state government schemes. Several states in the country had been operating relief funds, often housed in the chief minister’s office, which made discretionary grants for high-cost illnesses, based on the patient’s financial status. Anecdotal evidence suggests that grant allocations were often inequitable and patronage driven, and resulted in out-of-pocket spending. With its initial list of covered illnesses stemming from applications for such grants, Andhra Pradesh institutionalized this discretionary grants program into a health insurance scheme. Subsequently, other states such as Himachal Pradesh also chose to convert a discretionary grants system into insurance-based entitlements for the state’s poorest citizens. Several other states are contemplating this option.
Notes 1. MOHFW 2009a (provisional estimations from 2005–06 to 2008–09). 2. Exceeded in Asia only by Pakistan, Cambodia, Myanmar, and Afghanistan in 2008 (WHO 2010). 3. In this chapter different sources of data on health spending are cited for different years. Not all data are consistent. Some data are available for certain years only, such as data based on national surveys (NSSO) and national health accounts (NHA). 4. These themes are discussed in greater detail in the paragraphs that follow.