Industry pushes for hybrid insurance model to achieve universal health coverage

Experts believe with implementation of the plan, India's health care would largely depend on the private sector

By Jyotsna Singh
Published: Tuesday 10 December 2013

A report released by the Confederation of Indian Industries (CII) on Monday recommended that a model which allows public sector to deliver services like antenatal care and immunization and private insurance to cater to emergency and curative services will be effective in implementation of universal health coverage.

The report, released at the Seventh Health Insurance Summit, said that in this model every family in India will be registered in single insurance scheme for all three levels of medical care—primary, secondary and tertiary. The services will be divided between the government and private players.
Public health experts have, however, criticized the model as they believe that with its implementation India's health care would depend largely on the private sector. The draft 12th year plan, had proposed the same model and had drawn a lot of flak from public health experts. Despite this, the final 12th Plan report maintained the same provision. The CII report is a step forward in that direction as it pushes for implementation of the provision.

‘Need to standardize treatments’
According to the proposed scheme, a family shall be the unit of cover and those who are not covered within the definition of a family can be included in the scheme by paying an extra premium. The report says that in due course of time, this will help establish a proper referral system and the doctors will be able to diagnose a disease and identify the type of care a patient needs.  This will take away pressure from tertiary healthcare units, which at present cater to primary needs as well.

Preventive Services: Antenatal care, Immunisation, Screening for specific diseases, ambulance service

Promotive Services: safe drinking water, Nutrition services, IEC services, Tobacco control, Sanitation, Councelling, Anti-vector measures

Curative Services: Outpatient care, Emergency services, Inpaient services, Delivery services, CEmOC services, ICU services, Follow-up care
“We need to establish proper referrals. A person needing primary healthcare service should be able to recover in a primary healthcare set up. The doctor whom a patient approaches first should be able to send the patient to the required facility after a proper diagnosis. Only patients who need high level of care should be referred to a tertiary care facility,” said Nishant Jain, deputy programme director at international non-profit Indo-German Social Security Programme GIZ and a contributor to the report. He added that detailed guidelines for treatment of every disease should be prepared so that extra medical tests or treatments which cost more can be avoided, thereby reducing the burden on insurance companies.

M Ramaprasad, member (non-life) Insurance Regulatory and Development Authority (IRDA) said, “The difference in costs involved in cashless scheme and reimbursement in insurance show a difference of nearly 20 per cent. It is known that cashless hospitalisation costs less as compared to an insurance where amount has to be reimbursed. This happens because hospitals charge from patient extra amount in case of reimbursement, much to the worry of the insurers.

The report emphasizes that agricultural labourers and the non-poor are yet to avail of proper health insurance in the country.

The world health report 2013: research for universal health coverage

Health care inequities in north India: Role of public sector in universalizing health care

Towards achievement of universal health care in India by 2020: a call to action

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