Effective inclusiveness of health insurance scheme by Tamil Nadu government for the poor

Abstract

Health care is the most important topic discussed across the world both in terms of political and economic development. Health care contributes significantly towards portion of the GDP. Overall, health impacts individuals, employers and communities in numerous ways. There are various short and long-term benefits of health promotion programme for business. And there is strong relation between Health and Economy. Better health leads to a stronger Economy. This article contains the exposure on health insurance Scheme introduced to the poor people in Tamil Nadu by the Government. India is not having uniform specific policy on curative health care across the country this study will contribute in framing the policy for anew Health Care System in India. Health care is a complex system and mixed ownership in India. India has made significant improvement in terms of health indicators, however, still it has long way to achieve Global average and is very low, when compared to the developed nations. In India, greater portion of total expenditure on health care is private and majority of this are directly from households to the private owned ones for the profit. Studies revealed that of health care spending are almost are out-of-pocket payment and is actually progressive. Private sector and NGO is the dominant sector, where people seeking are indoor care and ambulatory care (or outpatient care).India is a low-income country with one fourth of population is living below poverty line, and one third of illiterate population with skewed health risks. Insurance is limited to only a small proportion of people in the organized sector covering less than one tenth of the total population. There is insufficient and inadequate information about the various insurance schemes. Mostly, focuses on hospital expenses only. There is a lack of awareness on Health insurance scheme by the common citizen. Inspite of existing regulation in some States, the private sector continues to operate in an almost unruly manner. Health insurance can improve access to good quality healthcare only if it is able to provide for health care institutions with adequate facilities and skilled personnel at an affordable cost. In financing of health services, a country like India may in principle choose between public funding through general taxation or through private financing through health insurance. Public funding is justified where equity concern overrides efficiency objective. Where the opposite is true, dependency is often placed on the private insurance market. Equity considerations in private insurance market can generate inefficiency and market failure as it involves trade off between desired distribution and the distorted incentives that accompany such redistribution. Therefore, where equity is the prime consideration, it can best be achieved under public financing. In practice, no health financing system is either purely public or private. Most of the country follows mixed way of offering health service. However, choice between public health financing or private insurance is hardly available in India, because of the Governments limited ability to mobilise sufficient resources to fund entire health spending, and also because of the nature of employment. The strategy of free public health provision has not worked well in most States in India. Shrinking budgetary support to the public health services, shortage in man power, inefficiency in provision, and unacceptably low quality of these services is reflective of this, leads to formulation of a new Health policy. In this study to serve the poor people in Tamil Nadu, a novel insurance scheme has been introduced in 2009. Even after two years of introduction of the scheme, no study have been conducted on, whether the schemes main objective of the Government is fulfilled, the stake holders are getting benefit from the scheme, the scheme is financially viable or any modification is required. Good amount of data were collected from the Government of Tamil Nadu, through primary survey, and through RTI Act 2005. The analysis reveals that the scheme is well received by the Poor public as the lifesaving treatment for the poor in private Hospitals are dream for them. This paper has come out with good number of recommendations for improving the scheme, financial viability in long-run for all stake holders and a policy alternative for Government of India.