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Health Insurance

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Project log

Ramesh Bhat
added 2 research items
The report suggests focusing on following groups of organizations through which community/mutual-type insurance initiatives could scale up: (a) micro-finance institutions , and self-help groups, (b) the more than 600,000 cooperatives in India, (c) micro-enterprise and small- and medium-size enterprise clusters, (d) urban labor markets (such as auto driver unions) and migrant clusters in several cities in India. The report also observes that complete integration of primary health care into any mutual health program remains a challenge. The discussion suggests that this will require an in-depth understanding in areas such as (a) the nature and profile of outpatient care needs, (b) capturing data on outpatient service utilization, and (c) based on the data, developing an appropriate health insurance program and integrating it into the existing program. The report further notes that the voluntary form of health insurance experiences much bigger market failure challenges. These interventions are known in theory and practice as having sustainability and scalability challenges. However, this does not mean such interventions are not useful. When leadership and management know the challenges, they can make a difference in mitigating many of the unintended consequences of this instrument.
The objective of this report is to review the health financing challenge in India by presenting the findings of National Sample Survey Office (NSSO Round 71) data on out-of-pocket (OOP) spending on health. The paper specifically discusses the rural-urban differences in OOP spending and implications thereof. Given the complexity and challenges of the health system in India and the rural-urban differences, the responses need to be contextual and may differ. The paper then reviews the government response and landscape of health insurance and presents an opportunity map where health insurance options can be expanded. The paper describes broad strategies to develop a comprehensive health protection response to meet the health protection needs of urban India.