Dec 2021 Group 1&2&4 TNPSC important Study Material !!!
Why health insurance?
This is the first question that a planner needs to ask and answer. Why does the planner want to introduce health insurance at National / state / district / regional level? What is the need?
• Is there a problem of access to health care? Is the target population finding it difficult to access health care (primary or secondary)?
Is there a problem of impoverishment due to medical expenses? The population is able to pay the bills, but in the process has to borrow or sell their assets to meet these medical costs. This means that they may be pushed into poverty because of medical expenses. Health insurance could be a way of providing financial protection against high medical expenses.
Is there a problem of quality of health care? People have the capacity to pay, but are not getting good quality health care. Health insurance could be a way of negotiating with the providers for better quality health care.
Is there political pressure to start a health insurance programme? Is the Health Minister wanting to start a health insurance programme? This could be the wrong reason for starting health insurance in the state, but it could then be used to meet the above objectives - improving access and financial protection. Especially since there is high out of pocket payments by individual households in most of our states.
The ACCORD health insurance programme was started because the tribals did not have financial resources to access hospital care. They preferred to lie down in their huts and die. After introducing health insurance, the tribals now pay a small premium when they are healthy and avail of benefits when they are sick. They do not have to worry about money at the time of ilness.
The DHAN foundation discovered that the single largest reason for indebtedness among their SHG women was loans to meet medical expenses. After starting their health insurance programme, women no longer have to take a loan when they are sick, as they are protected by the health insurance programme.
With elections looming, the Assam government introduced a health insurance programme for its citizens. Unfortunately it was so poorly designed that it did not meet the needs of the people, especially the poor. Thus a golden opportunity to protect the poor was lost.
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