Bivin Jay B Mar Baselios College of Nursing
Bivin Jay B Mar Baselios College of Nursing
Bivin Jay B Mar Baselios College of Nursing
Vision insurance
Disability insurance
Dental insurance
Health Insurance In India
ESI
• introduced in 1948(amended in 1975, 1984
and 1989).
• Benefits of ESI
– Medical benefits
– Sickness benefits
• Extended & enhanced
– Maternity benefit
– Disability benefit
• Permanent disability benefit
– Dependants benefit
– Other benefits
Rajiv Gandhi Shramik Kalyan
Yojana
• Unemployment Allowance equal to 50% of
wage for a maximum period of upto one
year.
• Medical care for self and family from ESI
Hospitals/Dispensaries during the period
IP receives unemployment allowance.
• Vocational Training provided for upgrading
skills - Expenditure on fee/travelling
allowance borne by ESIC.
CGHS
• Established in 1954
• Services
– Emergency treatment,
– Outdoor services,
– Indoor services,
– Domiciliary visits,
– Specialist’s consultation,
– Antenatal, natal and postnatal services
– Family welfare services.
– Supplies optical and dental aids at reasonable rates.
– Laboratory and x-ray investigation
– Paediatric services including immunization
Other services
• Defense Medical services
• Railway Medical Care
• Community Health Insurance
– Provider model: NGOs act both as insurer and
provider of health care services.
– Insurance model: NGOs is the insurer and care
is purchased from a private provider.
– Intermediary model: NGOs is neither the insurer
nor care provider. It acts as an intermediary
between the target population and the insurance
provider.
RSBY
• RSBY is supposed to become operational
from 2008-2009 and all 600 districts of the
country to be covered by 2012.
• Objective:
– To provide health security for the Below
Poverty Line (BPL) workers in the
unorganized sector and their families through
an insurance that cover for hospital expenses.
• Provider: public and private sector.
Advantages
• Prevention: prevent diseases through early
detection and doctor recommended life style
changes. It keeps citizen healthier and saves
money
o Peace Of Mind: If a nagging problem (eg:
unusual pain) persists, they can conculut doctor
without expenses
o Less Lost Time: Get Sick leave, visit doctor
Issues/limitations
• Limited coverage
– Only around 10% of the population is covered
through health financing schemes
– Geographic spread in terms of health care
facilities and financing awareness is limited
– Selection criteria by suppliers often restricts
the poor (and more likely to be ill) from
affordable pre-payment schemes
• Moral hazard and Adverse selection
– Claims ratios for Mediclaim and Jan Arogya
policies have been in the range of 120 –
130%.
• System leakages
– Provider malpractices leading to over-charging or pre-
selection / selective recommendation
• Lack of universal schemes
– Limitations in terms of coverage of illnesses as well
as treatment options
– Alternative therapies often not considered / included
under insurance
Disadvantages
Cost
Lack of choices
Complicated rules
Limited access
Thank Yu