Assessing the Coverage Efficacy of Health Insurance for Major Illnesses in India

Sheuli Misra, World Health Organization (WHO)

This study examines whether health insurance’s effectiveness in reducing out-of-pocket (OOP) and catastrophic health expenditure (CHE) varies between major health conditions (NCD vs. non-NCDs) in India. The current health scenario indicates that Indians constantly faces a threat of CHE due to the rise in multimorbidity, chronic conditions, and persistent epidemic diseases under a substandard health care system. Indians now spend nearly a quarter of their household consumption on healthcare, a rising trend noted in the last few years. Despite the launch of PM-JAY in 2018, one of the world’s largest health insurance programs, the latest NSS health survey data (2017-18) reveals that only 16% population reported being covered by any health insurance scheme, a slight increase from 15.30% in 2014. Existing insurance schemes mainly cover in-patient expenditures with varying benefits across different health facilities and inadequate coverage for specific health conditions. Despite extensive literature on insurance’s ability to protect against OOPE/CHE, no studies have yet assessed how this protection varies by specific ill-health conditions. The results are expected to provide significant policy-relevant insights into health insurance uptake, and disease-specific coverage of insurance to deal with the current CHE burden and support progress towards the universal health coverage in India.

Keywords: Health and Morbidity, Economic Demography

See extended abstract.