Keeping the 'health' in health insurance.

Abstract

Illness is a leading cause of household financial crisis in India. Visit any slum or a village and a familiar story will emerge: a landless worker indebted for 10 years to pay for a child’s kidney operation; a family that sold its land to obtain private treatment for tuberculosis; or a young girl withdrawn from school to help care for a parent with cancer. A range of more systematic assessments confirms this basic story. 1 In principle, Indians can access subsidised health services provided by a public sector with extensive coverage. However, by almost any account, public sector health facilities offer care of poor quality, characterised by long waiting times, high rates of absenteeism among medical personnel, particularly in primary care facilities in rural areas, and unavailability of drugs (Garg and Karan 2009; Mahal 2002). This state of affairs has forced a large majority to depend on the private sector, mostly in the form of out of pocket spending that accounts for more than 70% of all health spending in India (National Commission on Macroeconomics and Health 2005). Two recent government initiatives seek

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