Indian Journal of Community Medicine

CME
Year
: 2012  |  Volume : 37  |  Issue : 3  |  Page : 142--149

Universal Health Insurance in India: Ensuring equity, efficiency, and quality


Shankar Prinja, Manmeet Kaur, Rajesh Kumar 
 School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India

Correspondence Address:
Shankar Prinja
Assistant Professor of Health Economics, School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh-160 012
India

Indian health system is characterized by a vast public health infrastructure which lies underutilized, and a largely unregulated private market which caters to greater need for curative treatment. High out-of-pocket (OOP) health expenditures poses barrier to access for healthcare. Among those who get hospitalized, nearly 25% are pushed below poverty line by catastrophic impact of OOP healthcare expenditure. Moreover, healthcare costs are spiraling due to epidemiologic, demographic, and social transition. Hence, the need for risk pooling is imperative. The present article applies economic theories to various possibilities for providing risk pooling mechanism with the objective of ensuring equity, efficiency, and quality care. Asymmetry of information leads to failure of actuarially administered private health insurance (PHI). Large proportion of informal sector labor in India«SQ»s workforce prevents major upscaling of social health insurance (SHI). Community health insurance schemes are difficult to replicate on a large scale. We strongly recommend institutionalization of tax-funded Universal Health Insurance Scheme (UHIS), with complementary role of PHI. The contextual factors for development of UHIS are favorable. SHI schemes should be merged with UHIS. Benefit package of this scheme should include preventive and in-patient curative care to begin with, and gradually include out-patient care. State-specific priorities should be incorporated in benefit package. Application of such an insurance system besides being essential to the goals of an effective health system provides opportunity to regulate private market, negotiate costs, and plan health services efficiently. Purchaser-provider split provides an opportunity to strengthen public sector by allowing providers to compete.


How to cite this article:
Prinja S, Kaur M, Kumar R. Universal Health Insurance in India: Ensuring equity, efficiency, and quality.Indian J Community Med 2012;37:142-149


How to cite this URL:
Prinja S, Kaur M, Kumar R. Universal Health Insurance in India: Ensuring equity, efficiency, and quality. Indian J Community Med [serial online] 2012 [cited 2019 Sep 18 ];37:142-149
Available from: http://www.ijcm.org.in/article.asp?issn=0970-0218;year=2012;volume=37;issue=3;spage=142;epage=149;aulast=Prinja;type=0