Role of health insurance in enabling universal health coverage in India: A critical review

Abstract

India has set itself a long-term goal of providing universal health coverage for all its citizens and over the past few decades, significant progress has been achieved by the government, towards meeting this goal. But, due to funding inadequacy, public health infrastructure continues to suffer from perennial shortages, impacting the rural and indigent population segments the most. As a consequence of these shortages, nearly 70% of health spending is borne by households, out-of-pocket sources, and delivered by private health care facilities. This scenario usually leaves the families impoverished and in debt, as private sector medical costs are mostly unaffordable. Universal health coverage in India is, hence, severely constrained by resource shortages and affordability. Health insurance, which has made a presence in India over the past decade, can deliver a solution to the above challenges. While, government health insurance schemes have demonstrated varying degrees of success, funding shortfalls have constrained their expansion plans. Private health insurance, on the other hand, can recalibrate their approach and play a significant role in spreading universal health coverage. By developing a strategy of addressing primary care needs and intelligently coexisting with public health insurance, private health insurance can provide an immense boost to universal coverage, by providing affordable health care access for all Indian citizens.