Health Insurance Scenario in Gujarat – An Insight
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Health Insurance Scenario in Gujarat – An Insight

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Neha Lal, Senior General Manager – Operations & HR, GCS Medical College

The percentage of India’s national budget allocated to the health sector remains one of the lowest in the world, and healthcare expenditures are largely out-of-pocket (OOP), writes Neha Lal, Senior General Manager – Operations & HR, GCS Medical College, Hospital & Research Centre, Ahmedabad for Elets News Network (ENN).

Currently, efforts are being made to expand health insurance coverage as a means of addressing health disparity and reducing catastrophic health costs.

In this review, we document reasons for rising interest in health insurance and summarise the country’s history of insurance projects to date. We note that most of these projects focus on in-patient hospital costs, not the larger burden of out-patient costs.

We briefly highlight some of the more popular forms that government, private, and community-based insurance schemes have taken and the results of quantitative research conducted to assess their reach and cost-effectiveness.

Drawing on preliminary fieldwork and recognising the need for a broad-based implementation science perspective (studying up, down and sideways), we have identified six key topics demanding more in-depth research, among others: (1) public awareness and understanding of insurance; (2) misunderstanding of insurance and how this influences healthcare utilisation; (3) differences in behaviour patterns in cash and cashless insurance systems; (4) impact of insurance on quality of care and doctor-patient relations; (5) mistrust in health insurance schemes; and (6) health insurance coverage of chronic illnesses, rehabilitation and OOP expenses.

Considering these challenges of healthcare insurance, there are many schemes launched by Government of Gujarat / India, which are being operated through TPAs and Insurance companies to cater larger uninsured mass, needing healthcare services in Gujarat. Some of them are:

Rashtriya Swasthya Bima Yojana (RSBY)

It is India’s largest health insurance scheme. Launched in 2007 by the Central Government, it covers over 37 million people, mostly poor families, across the States. It represents a major departure from past approaches to government support for healthcare in India.

Mukhyamantri Amrutum (MA) Yojana

It was launched on 4th September, 2012 by the Government of Gujarat for the Below Poverty Line (BPL) and Lower Income Group (LIG) population, is especially vulnerable to the catastrophic health risks.

The scheme aims to improve access of BPL families to quality medical and surgical care for identified diseases involving critical illness like Burns, Cardiology, Cardiothoracic Surgery, Cardiovascular Surgery, Renal, Neurosurgery, Paediatric Surgery, Polytrauma, Medical Oncology, Radiation Oncology, Surgical Oncology, Joint Replacement Packages and Transplantation Procedures.

Rogi Kalyan Samiti (A Poor Patients Benefit Scheme)

Under this innovative scheme the Department of Health, Government of Gujarat, has put Rs 4 crores as fixed deposit. The interest incurred is spent on the medical expenditure of poor patients up to a limit of Rs 15,000/ per patient. Since the program became operational a total of 944 patients have been benefited and Rs 1,23,08,400 have been spent on relief till 14th July 2004. Benefit utilisation has increased in the last 2-3 years significantly. In 2001-2002, relief of 4.31 lakh was utilised which increased to Rs 12.80 lakhs in 2002-03 and Rs 80.54 lakhs in 2003-04.

This scheme covers major cardiac illnesses, all types of cancer, neurological, nephrological and ophthalmological problems. Any other super specialty treatment identified by the Governing Body is also covered under this scheme.

Bal Sakha Yojana

Under this scheme, all babies born to BPL mothers in the State (approximately 3,00,000 births per annum) will be covered for neonatal care by partnering pediatricians, including care in their Neonatal Intensive Care Unit (level 2 ) at no cost to the beneficiary. After initialisation and stabilisation of the Scheme, the scheme may be extended to cover all infants up to one year age.

Janani Suraksha Yojana (JSY)

It’s a safe motherhood intervention under the National Rural Health Mission (NRHM) being implemented with the objective of reducing maternal and neo-natal mortality by promoting institutional delivery among the poor pregnant women. The Scheme has contributed immensely in increasing the Institutional deliveries among the BPL, ST and SC population.

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