Ayushman Bharat
In 2018, India launched its state sponsored health Insurance scheme, with the name “Ayushman Bharat” which means “longevity for India”. It is a fully government sponsored scheme aimed to ensure that “each and every citizen receives his due share of health care.” It undoubtedly has become “world’s largest government funded healthcare program”. As per the dashboard of the program in first eight years of its launch, it has issued more than 42 crore beneficiary cards, and has facilitated more than 10 crore hospital admissions.
This scheme provides cashless coverage of upto 5 lakh per family per year, for vulnerable low income families. This coverage across public health system, as well as in select private sector facilities is currently meant for hospital admissions. In 2024 the scheme was extended to all those above 70 years of age. This widened its spectrum, and became another step towards provision of universal health care (UHC).
The implementation of the scheme is through an online platform, ensuring that its various steps are paperless. A key feature is bio-metric enabled registration and identification of the beneficiary through “Universal Identification Authority of India” or UIDAI’s Aadhar system. The word “Aadhar” translates in English to “Basis”, and the system has grown to become a basis for various state run schemes in the India.
While, Universal Health Care is not a new concept, its scope has remained debatable. The word “universal” means only the basic health needs and emergencies, or should it extend to entirety of health-care. Does “universal” really means all, or be limited only to the most vulnerable. Can we draw a line somewhere, or cater to seemingly utopian “universal”.
Since independence, entire public health system in India (a network of primary, secondary, and tertiary care facilities) was envisioned to provide health-care at no-cost for all. However, we also have a vast privately owned health-care. While it is fragmented, yet it also provides majority of care at all levels. Over the years, the health care amenities, as well as need have vastly expanded. As public health system could not meet all the expectations, it is important to include private sector to realize UHC.
Employee State Insurance
A forerunner of “Ayushman Bharat” scheme is “Employee state insurance scheme” or ESI. This scheme was envisioned in 1948, and launched in 1952. It is aimed at factory workers, which now includes all industrial establishments with 10 or more employees.
ESIC itself runs about 160 hospitals in the country (51 of these directly) and around 1500 dispensaries in the country. It has about 15 crore employees in the organized sector as its beneficiaries. This is in-fact a dedicated health system for this sector.
Employee health Insurance depends on a deductible, or an amount collected as a fixed deduction from each employee and a contribution from employers. On the other hand Ayushman scheme is fully sponsored by the government, payed by taxpayers, which means that registered beneficiaries do-not need to pay any separate contribution.
Life insurance schemes in India
On the other hand pure life or event insurance schemes do-not provide repetitive health coverage. Two of the oldest govrnment run insurance systems in India are Life insurance corporation (LIC) and Postal Life insurance (PLI). LIC is the largest insurance provider in the country, in which government of India retains about 96.5% of share.
Global Social insurance systems for health
Health insurance schemes are more ambitious than the ones that insure for life or accidents. As healthcare becomes more complex, the schemes also need to evolve to provide maximum benefit. This is specially true for social or tax-based health insurance, which aspires to provide for populations or its subgroups. It is always a struggle to fulfill these aspirations and provide for maximum health benefits.
Despite benefits of social or tax based insurance systems, its criticisms are also not unexpected. Often access to health-care remains with those who are comparatively more affluent. Further, lesser heath-care needs tend to burden the system, and more pressing ones may get left behind. As cost of health-care rises, insurance mechanisms run a risk of dwindling resources. Experienced national social insurance systems, have all faced these criticisms.
Unlike the private insurance systems, Tax based or Social insurance systems provide coverage to more individuals, especially the underprivileged. Hence, it is an important step to realize UHC goal. It puts the onus on the governments to increase health spending, and ensure that provision of affordable health-care remains a priority.As the coverage expands from most vulnerable to others, we may be on the pathway towards its realization.
