Health Insurance


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Micro Health Insurence Models

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Health Insurance

  1. 1. Health Insurance By: Kushwaha Sikander, Behra Sitakant, Pandey Sudhir Kumar, Swati, Sushil Justin
  2. 2. Health Insurance <ul><li>The term health insurance is generally used to describe a form of insurance that pays for medical expenses. It is sometimes used more broadly to include insurance covering disability or long term nursing or custodial care needs. It may be provided through a government-sponsored social insurance program, or from private insurance companies. </li></ul>
  3. 3. Present Health Care Scenario in India <ul><li>India spends about 6.5 to 7% of GDP on Health care (official estimates around 6%) out of which 1.2% is in the Govt. sector (this accounts for 22% of overall spending) and 4.7% in private sector (78% of overall spending). </li></ul>
  4. 4. Health Insurance at a Glance <ul><li>According to recent news report Health insurance continues to be the fastest growing segment with annual growth rate of 55%. Health Premium has risen to Rs. 3300 crores in 2006-2007. </li></ul><ul><li>As per the recent reports from various agencies the Health sector has the potential to become a Rs. 25000-crore industry by 2010 . </li></ul><ul><li>On August 15, 2007 Prime Minister has announced Rs 2000 Crores for Health Insurance for poor citizens. We foresee that this amount will be partly in form of subsidy therefore during calendar year 2008 we can expect Health Insurance premium to touch figure in the range of Rs 10,000 Crores. </li></ul>
  5. 5. Community Health Insurance <ul><li>CHI is “any not-for-profit insurance scheme that is aimed primarily at the informal sector and formed on the basis of a collective pooling of health risks, and in which the members participate in its management.” </li></ul>
  6. 6. Why CHI <ul><li>In recent years, community health insurance (CHI) has emerged as a possible means because of: </li></ul><ul><ul><li>(1) improving access to health care among the poor; and </li></ul></ul><ul><ul><li>(2) protecting the poor from indebtedness and impoverishment resulting from medical expenditures. </li></ul></ul>
  7. 7. Design of CHI Schemes
  8. 8. Type – II Design
  9. 9. Type – III Design
  10. 10. Conditions For success of CHI <ul><li>– An effective and credible community based organization; </li></ul><ul><li>– An affordable premium; </li></ul><ul><li>– A comprehensive benefit package is necessary to convince the community of the benefits of health insurance. </li></ul>
  11. 11. RASHTRIYA SWASTHYA BIMA YOJANA <ul><li>On August 15, 2007, Prime Minister Manmohan Singh announced the creation of a new health insurance scheme; the Rashtriya Swasthya Bima Yojana or RSBY to protect the health of poor people. (The scheme was formally launched on October 1, 2007) </li></ul>
  12. 12. Objective <ul><li>Recognizing the diversity with regard to public health infrastructure, socioeconomic conditions and the administrative network; </li></ul><ul><li>The health insurance scheme aims to facilitate launching of health insurance projects in all the districts of the States in a phased manner for BPL workers. </li></ul><ul><li>The definition of BPL is the one prescribed by the Planning Commission. </li></ul>
  13. 13. Benefits <ul><li>The beneficiary shall be eligible for such in-patient health care insurance </li></ul><ul><li>benefits as would be designed by the respective State Governments based on the </li></ul><ul><li>requirement of the people/ geographical area. The unorganized sector worker and his family (unit of five) will be covered. </li></ul><ul><li>Total sum insured would be Rs. 30,000/- per family per annum on a family floater basis. </li></ul><ul><li>Cashless attendance to all covered ailments </li></ul><ul><li>Hospitalization expenses, taking care of most common illnesses with as few </li></ul><ul><li>exclusions as possible. </li></ul><ul><li>All pre-existing diseases to be covered </li></ul><ul><li>Transportation costs (actual with maximum limit of Rs. 100 per visit) within an overall limit of Rs.1000. </li></ul>
  14. 14. Selection of Insurance Provider <ul><li>The selection of the health insurance provider shall be done by the state/implementing agency through tendering process inviting both Public and Private Insurers for better terms of reference. The State Government would formulate the projects and determine the implementing agency such as Insurance Trust/ Insurance Cell/Mother NGO etc. to monitor/supervise the scheme and integrate with insurance company. This would be further monitored at State and Central level. </li></ul>
  15. 15. Approval and Monitoring Committee <ul><li>A Committee consisting of the following shall examine the proposals submitted by the State Governments and grant approval to the projects: </li></ul><ul><li>i) Joint Secretary/Director General Labour Welfare, </li></ul><ul><li>Ministry of Labour & Employment Convener, </li></ul><ul><li>ii) Representatives of Ministry of Finance Member </li></ul><ul><li>iii) Representatives of Ministry of Health and Family Welfare Member </li></ul><ul><li>iv) Representatives of Planning Commission Member </li></ul><ul><li>The Committee will also periodically monitor and review the progress of the projects. </li></ul>
  16. 16. Monitoring and Evaluation <ul><li>The State Government will put in place a well defined mechanism for monitoring and evaluation of the pilot project at the time of its implementation. At the Central Government level, the Cell constituted for examining project proposals shall also periodically monitor and evaluate the performance of each pilot project with a view to evolving workable models which can be up-scaled for wider application. </li></ul>
  17. 17. Issues and Concerns in Insurence <ul><li>The Indian private health sector is unregulated and unaccountable. </li></ul><ul><li>Financial sustainability. </li></ul><ul><li>Uncovered disease which is covered in all the govt. schemes. Like RCH. </li></ul><ul><li>Inadequate information regarding health, disease, procedures & treatments, costs & outcome </li></ul>
  18. 18. Suggestion <ul><li>Covered all the disease; </li></ul><ul><li>Speedy settlement of claims; </li></ul><ul><li>Premium should be low; </li></ul><ul><li>Quality of service when facilities are owned by the plan giver; & </li></ul><ul><li>Give feasible alternative to community based organisations and movements exist in India. Only thing is to regulate the providers and to legislate so that the community health insurance programmes find a space within the Indian insurance context. </li></ul>
  19. 19. <ul><li>Thank You </li></ul>