India has a form of universal healthcare. The Indian Constitution states that everyone has the right to health and makes healthcare the responsibility of the state rather than that of the central government. Despite the state funded healthcare, there is a severe shortage of resources and many people end up paying out-of-pocket for services. Over the years there have been various government-funded health insurance programs aimed at different populations and within different state governments. For lower-income people, the government launched the National Health Protection Scheme (Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana, or PM-JAY) which is financed by taxes. It allows people to also get cashless services at private facilities.
There are also a handful of health insurance programs for specific population groups like government employees and factory workers. Private voluntary insurance is available, but uptake is limited. One of the biggest programs designed for lower-income populations with the aim of lowering financial burdens is the National Health Insurance Program (Rashtriya Swasthya Bima Yojana, or RSBY). It was launched in 2008 and by 2016, around 41 million families were covered by it. Due to the ineffectiveness of some programs and the limited availability of commercial insurance, only 37% of the population had health coverage in 2018. With the creation of the PM-JAY in 2018, about 40% of the lower-income population has hospital coverage. They’ve also started to reform current health facilities into Health and Wellness Centers.
What is covered depends on the insurance program. Under PM-JAY, secondary and tertiary care are covered, but not outpatient care. The Central Government Health Scheme and Employees’ State Insurance Corporation cover all types of care, including outpatient care and drugs. Under other publicly subsidized insurance coverage, all secondary, tertiary, pre-hospital, and post-hospitalization treatment are covered.
Most of the publicly funded health insurance programs, like RSBY, only provide hospital coverage for people living below the poverty line. Primary care and outpatient care are not covered by it. Eligibility is based on a household’s level of need defined by the Socio-Economic Caste Census. The program extends coverage to approximately 100 million families. People are auto-enrolled in the system and are able to use benefits as cashless transactions. The National Health Protection Scheme is funded under the existing budget for the RSBY, which doubled from 2018 because of expanding public insurance costs. States also run their own health programs, similar to that of RSBY. There are also public sector undertakings (state-owned enterprises) and other government bodies like central and state universities that offer health coverage to their employees.
The Central Government Health Scheme is another important program. It is organized and run by the Ministry of Health and Family Welfare for central government employees and their dependents. There are no income requirements to be eligible. It also includes coverage for alternative medicine. Around 3.6 million people were registered in 2019. Similar programs exist for railway and defense employees. India has only one health insurance program that empolyers and employees contribute to, the Employees’ State Insurance Scheme. Coverage includes maternity care, as well as disability and death benefits for employment-related injuries.
Due to government healthcare coverage people can get free care in public health facilities with no deductibles, co-payments, or coinsurance. However, because of accessibility issues and since government funded healthcare is limited, a lot of care is provided at high-priced private facilities. These are typically paid out-of-pocket for the patients. This means that out-of-pocket payments have been the main means of funding healthcare, accounting for 65% of total health costs in 2016. Due to a lack of insurance and high out-of-pocket costs, around 8% of the population is being pushed below the poverty line. One of the main reasons for launching the National Health Protection Scheme was to help low-income families with healthcare costs.
India has made significant efforts in recent years to help provide healthcare to its citizens and to help lower the financial burden of adequate healthcare. While it has helped curb some of the costs there are still high out-of-pocket costs for patients. The various state and central insurance programs have made healthcare more widely available, but it is typically only the most basic of coverage with private insurance picking up the slack for those who can afford it. For those who can’t afford private coverage along with the national programs usually end up in debt.
The quality of healthcare for those in a large city is vastly different for those in smaller, rural communities. It is also severely different for wealthier urban residents and the poorer urban residents. Large social, health and income inequalities exist in India, many of them a result of India’s diversity and rapid economic growth. The largest under-served community in India are women in rural communities. They lack access to family planning services, neonatal care and reproductive health services.
However, India has been making changes to ensure quality for all patients in recent years. Health care facility accreditation is well-developed in India. The National Accreditation Board for Hospitals and Healthcare Providers is responsible for accrediting all types of health facilities. This board is a member of the International Society for Quality in Health Care, along with countries such as Australia, Hong Kong, and the United Kingdom. The accreditation criteria are based on international best practices from these member countries.
Even though there are many issues still being worked out with the status of healthcare in India they are working on at least giving basic coverage to everyone. Healthcare is considered a right in India, unlike in the United States. However, in both countries, no matter the type of insurance, there are significant out-of-pocket costs than can ruin families.