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    Health Insurance: Pramod Kumar

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    Suneel Kumar Prajapati
    Health insurance covers the costs of an individual's medical and surgical expenses. It protects individuals from high, unexpected medical costs and makes quality treatment more affordable. There are several types of health insurance schemes in India including voluntary private schemes, employer-based schemes, community-based schemes, and mandatory government schemes like the Central Government Health Scheme and Rashtriya Swasthya Bima Yojana. Lack of health insurance coverage is found to reduce emergency department visits by 40% and inpatient hospital admissions by 61%.

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    Health Insurance: Pramod Kumar

    Uploaded by

    Suneel Kumar Prajapati
    146 views21 pages
    Health insurance covers the costs of an individual's medical and surgical expenses. It protects individuals from high, unexpected medical costs and makes quality treatment more affordable. There are several types of health insurance schemes in India including voluntary private schemes, employer-based schemes, community-based schemes, and mandatory government schemes like the Central Government Health Scheme and Rashtriya Swasthya Bima Yojana. Lack of health insurance coverage is found to reduce emergency department visits by 40% and inpatient hospital admissions by 61%.

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    Health insurance covers the costs of an individual's medical and surgical expenses. It protects individuals from high, unexpected medical costs and makes quality treatment more affordable. There are several types of health insurance schemes in India including voluntary private schemes, employer-based schemes, community-based schemes, and mandatory government schemes like the Central Government Health Scheme and Rashtriya Swasthya Bima Yojana. Lack of health insurance coverage is found to reduce emergency department visits by 40% and inpatient hospital admissions by 61%.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    146 views21 pages

    Health Insurance: Pramod Kumar

    Uploaded by

    Suneel Kumar Prajapati
    Health insurance covers the costs of an individual's medical and surgical expenses. It protects individuals from high, unexpected medical costs and makes quality treatment more affordable. There are several types of health insurance schemes in India including voluntary private schemes, employer-based schemes, community-based schemes, and mandatory government schemes like the Central Government Health Scheme and Rashtriya Swasthya Bima Yojana. Lack of health insurance coverage is found to reduce emergency department visits by 40% and inpatient hospital admissions by 61%.

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    © All Rights Reserved
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    of 21

    HEALTH INSURANCE

    PRAMOD KUMAR
    HEALTH
    Health is defined as "a state
    of complete physical,
    mental, and social well-
    being and not merely the
    absence of disease or
    infirmity."
    HEALTH INSURANCE
    Health insurance is a
    type of insurance
    coverage that covers
    the cost of an insured
    individual's medical
    and surgical
    expenses.
    NEED
    HEALTH
    INSURANCE
    WHEN YOU
    ARE IN NEED HEALTH
    INSURANCE
    PROTECTS
    TAX BENEFIT YOU FROM
    HIGH,
    UNEXPECTED
    COSTS
    MAKE
    CASHLESS QUALITY
    SERVICE TREATMENT
    AFFORDABLE
    Health insurance in India is very limited covering
    about 13% of the total population. The existing
    schemes can be categorized as:
    1. Voluntary health insurance schemes or private for
    profit schemes:
    • In the public sector, the general insurance
    corporation (GIC) and its four subsidiary
    companies (National insurance, corporation, new
    India assurance company, oriental insurance
    company and united insurance company) and life
    insurance corporation (LIC) of India provide
    voluntary insurance schemes.
    • Currently, a few companies such as bajaj alliance,
    ICICI, Royal sundaram, and cholamandalam among
    others are offering health insurance schemes.
    2. Employer-based schemes:
    • The railway, defense and security forces,
    plantation sector and mining sector medical
    services and / or benefits to its own
    employees.
    3. Insurance offered by NGOs/ community
    based health insurance:
    Some examples of community based health insurance
    schemes are:
    • self employed women’s association (SEWA)
    • AMUL Dairy cooperatives in Gujrat,
    • The mallur milk cooperative in Karnataka
    • Action for community organization, rehabilitation
    and development (ACCORD) nilgiris
    • Kadamalai kalanjia vattara sangam (KKVS) Madurai
    • Voluntary health agencies (VHS) Chennai
    • Raigarh ambikapur health association (RAHA)
    Chhatisgarh
    4. Mandatory health insurance schemes or
    government run scheme:
    • The government- run schemes includes the
    central govt. health schemes (CGHS) and the
    employees state insurance schemes (ESIS).
    CENTRAL GOVERNMENT HEALTH
    SCHEME (CGHS)
    The Central Government Health Scheme
    (CGHS) was started under the Indian
    Ministry of Health and Family Welfare in
    1954 with the objective of providing
    comprehensive medical care facilities to
    Central Government employees,
    pensioners and their dependents residing
    in CGHS covered cities.
    The scheme was initially started in Delhi in 1954.
    Subsequently CGHS Services were extended to
    the following 17 cities: Allahabad, Ahmedabad,
    Bangalore, Mumbai, Kolkata, Hyderabad, Jaipur,
    Jabalpur, Lucknow, Chennai, West Bengal,
    Nagpur, Patna, Pune, Kanpur,
    Thiruvananthapuram and Guwahati.
    The Central Govt. Health Scheme is applicable to the
    following categories of people residing in CGHS
    covered cities:
    • All Central Govt. Servants paid from Civil
    Estimates (other than those employed in Railway
    Services and those employed under Delhi
    Administration except members of Delhi Police
    Force).

    • Pensioners drawing pension from Civil Estimates


    and their family members (Pensioner residing in
    non- CGHS areas also may obtain CGHS Card from
    nearest CGHS covered City)
    The medical facilities are provided through
    Wellness Centers (previously referred to as
    CGHS Dispensaries) /polyclinics under
    Allopathic, Ayurveda, Yoga, Unani, Siddha and
    Homeopathic systems of medicines. v 254
    allopathic dispensaries, 19 polyclinics.78 Ayush
    dispensary/ units, 3 Yoga Centers, 65
    Laboratories v 17 Dental Units.
    THE MAIN COMPONENTS OF THE
    SCHEME
    • The dispensary services including domiciliary care.
    M.C.H. Services.
    • Specialist’s consultation facilities both at
    dispensary, polyclinic and hospital v level including
    X-Ray, ECG and Laboratory Examinations.
    • Hospitalization.
    • Organization for the purchase, storage, distribution
    and supply of medicines v and other requirements.
    • Health Education to beneficiaries.
    RASHTRIYA SWASTHAYA BIMA YOJNA
    (RSBY)
    • Central govt. health insurance scheme for the
    Below Poverty Line (BPL) families in the
    unorganized sector.
    • It was formally launched on October 1, 2007.
    • The majority of the financing, about 75 % is
    provided by govt. of India, while remainder is paid
    by the state govt.(25%).
    • The registration fees of Rs. 30 would be collected
    from the beefier by the insurance company and
    adjusted against the payment of premium to be
    made to the insurance company by the state govt.
    BENEFITS:
    Hospitalization expense upto Rs. 30,000

    Over 725 pre-defined surgical packages

    Maternity newborn care

    Day care services

    Cover all pre-existing diseases

    1 day pre and 5 days hospitalization expenses.


    Transportation costs (Rs. 100 per visit) with
    overall limit of Rs. 1000 per year.
    EXCLUSIONS
    Conditions that
    do not require
    hospitalization.
    Congenital
    Suicide external
    diseases

    Drug and
    War, nuclear
    alcohol
    invasion
    induced illness

    Sterilization and
    Vaccination. fertility related
    procedures.
    CHALLENGES:
    • Limited Influence over healthcare delivery
    mechanism
    • High claim ratio – Around 140%
    • Low level of consumer Awareness
    • Limited product development
    • Limited knowledge for staff/Agents
    • Pricing demands from Insurance companies
    • Lack of proper communication between TPAs
    and Hospitals
    • Delay in Settlement of Claims
    • Lack of Training support from Insurers as well
    as TPAs
    • Preexisting diseases disputes between
    consumer and TPAs
    • Different Insurance Companies – different
    policies, terms etc
    RESEARCH ARTICLE:
    The Effect of Health Insurance Coverage on the Use of Medical
    Services Michael Anderson, Carlos Dobkin, Tal Gross NBER
    Working Paper No. 15823 Issued in March 2010
    Substantial uncertainty exists regarding the causal effect of
    health insurance on the utilization of care. Most studies cannot
    determine whether the large differences in healthcare
    utilization between the insured and the uninsured are due to
    insurance status or to other unobserved differences between
    the two groups. In this paper, we exploit a sharp change in
    insurance coverage rates that results from young adults "aging
    out" of their parents' insurance plans to estimate the effect of
    insurance coverage on the utilization of emergency department
    (ED) and inpatient services.
    Using the National Health Interview Survey (NHIS) and a
    census of emergency department records and hospital
    discharge records from seven states, we find that aging out
    results in an abrupt 5 to 8 percentage point reduction in the
    probability of having health insurance. We find that not having
    insurance leads to a 40 percent reduction in ED visits and a 61
    percent reduction in inpatient hospital admissions. The drop
    in ED visits and inpatient admissions is due entirely to
    reductions in the care provided by privately owned hospitals,
    with particularly large reductions at for profit hospitals. The
    results imply that expanding health insurance coverage would
    result in a substantial increase in care provided to currently
    uninsured individuals.

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