Results and Cross-Cutting Issues
39
least for the defined benefits packages. Over this same period, commercial insurers also made impressive strides in coverage expansion, registering an estimated four-fold increase in coverage. With 243 million persons estimated to be covered in the major government-sponsored health insurance schemes (table 3.1), the authors estimate that more than 300 million persons, about 25 percent of India’s population, now have access to some form of health insurance.3 This estimate includes coverage by schemes not reviewed in this book, including those for government employees and pensioners managed by the Railways and Defense departments, targeted government schemes such as those sponsored by the Department of Handlooms and Handicrafts, and the community-based self-managed schemes.4 In light of current trends, and assuming continued political and financial support from government, insurance coverage is expected (perhaps conservatively) to reach more than 630 million persons, 50 percent of the population by 2015. Most of the growth is likely to occur along three lines: RSBY, commercial insurance, and state-sponsored schemes. RSBY aims to reach 60 million families by 2015 (roughly 300 million members), and will account for most of the growth in GSHISs. State schemes such as Vajpayee Arogyashri (VA) in Karnataka will continue to expand.5 Other potential drivers of growth are commercial insurance as well as new state schemes in the planning stage. As mentioned above, other states will be introducing new schemes. Any additional states that launch schemes will further expand coverage, increasing membership well above the projected 630 million.6 India’s rapid economic growth is creating a large middle- and uppermiddle class that can afford to buy mostly individual and family plans from commercial insurers. According to the National Commission for Enterprises in the Unorganized Sector (NCEUS 2009), about 23 percent of the population (270 million people in 2010) can be categorized as middle class and higher and the remaining 77 percent as poor or vulnerable. Therefore, 23 percent may represent an upper limit on potential coverage through private voluntary health insurance (PVHI).7 Because of its linkage to the formal economy, ESIS will probably experience slow growth. NCEUS (2009) estimates that between 1992– 93 and 2005–06 national income grew by 125 percent. However, economic growth has had no impact on formal employment growth as a percent of total work force. Informal workers remained at about 92 percent of the workforce over this period. Most of the growth in ESIS