Health Insurance Cover and the Poor Sections of People in India
Updated On Apr 08, 2021
With the rapidly rising cost of medical facilities and a rampant increase in the spread of diseases, a health insurance policy is a basic necessity of human life today. In our country, a large percentage of the population is still below the poverty line and suffers due to barriers in accessing good medical facilities for ailments and illnesses. A health insurance is essential not only for the well-to-do sections of the society but it is even more necessary for the economically weaker sections of the society.
These low-income groups of society will always prefer the Government health care services in case of medical emergencies. But, the conditions of Government health care services in India have been deteriorating day-by-day due to lack of proper doctors, poor management, low-quality services and lack of advanced medical facilities. The private sector medical facilities are unaffordable for these people and if afforded, will make their financial condition even more miserable due to selling or mortgaging assets, spending all the savings, etc.
Statistics of Health Insurance Cover in India
For low and middle income class people, obtaining a good healthcare treatment at a private hospital looks like a distant dream even till date. As per the statistics, it is revealed that less than one fifth of the total population in India has a considerable health insurance plan. And individuals who have an health insurance plan, approximately 70% are covered under various government schemes.
This low penetration of health insurance plans over India is one of the major reasons why many individuals today are propelled towards poor health and poverty. In the absence of a proper health insurance plan, low income group individuals have no choice other than to meet these expenses from their own pocket in order to receive good healthcare facilities----- and proper health care treatment is quite expensive.
Inflation in Healthcare Facilities
It is a matter of fact that the cost of health care facilities is growing very rapidly and the sector is witnessing massive inflation. According to various surveys, the health care cost in India is to rise at the double the rate of inflation in 2018. This is going to be a big problem for not only the low-income groups but also for the middle-class sections of the society. Availing good quality medical care is going to be a tough task in the upcoming period, and the only saviour in such a situation is a health insurance policy. Many eminent health insurance policies such as Max Bupa Health Companion Health Insurance plan, ICICI Lombard Complete Health Insurance-iHealth, Religare Health Insurance-Care, Bajaj Allianz Health Guard plan, etc. provide comprehensive coverage during medical emergencies.
Top Benefits of Health Insurance Policy for Low and Middle-Income Groups
Let us discuss the major benefits health insurance policies will have for the low and middle-income groups.
1. Coverage of pre-hospitalisation and post-hospitalisation expenses
Health insurance plans will provide coverage for the various diagnosis and tests that are carried out before the actual hospitalization of the life insured. Moreover, even after the patient is discharged from the hospital, there might be certain tests and treatments which are needed to be carried out. Health insurance plans also cover these.
This will highly benefit people belonging to low-income groups as it would reduce the financial burden on them regarding the expenses related to medical tests and diagnosis.
2. Cashless hospitalisation
This is a significant benefit of health insurance policy as cashless treatment will be highly essential during the period of a medical emergency. With a health insurance policy, there is no need to worry about the settlement of medical bills as in the network hospital of the insurance provider the medical bills will be settled between the insurance provider and the hospital.
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3. Critical illness cover
Several critical illnesses such as heart attacks, cancer, major organ transplantation, kidney failure, paralysis, etc. require very intensive medical treatment and advanced medical facilities. Along with it, the cost of this treatment is very high and continues for a very long period. These types of illnesses and their treatment can aggravate the situation of poverty further amongst the people who come within the low-income bracket.
Health insurance policies can be helpful in these cases up to a certain extent as most of the health insurance plans provide a lump sum amount on the diagnosis of these critical illnesses and also a portion of this lump sum amount can be utilized in the form of a monthly income to compensate for the loss of income in a family.
4. Coverage for other additional expenses
Health Insurance policies will provide coverage for many other additional expenses such as ambulance expenses, domiciliary expenses, OPD expenditure, alternate treatment methods, room rents, etc. This expenditure tends to be a big burden on the people belonging to low-income groups at the time of medical emergency.
However, not many people in India belonging to the lower-income group are covered by health insurance policies due to ignorance and lack of awareness. Most of the people who are even covered by health insurance plans are under Government schemes.
Most Popular Government Health Insurance Schemes
Since the majority of the population in India belongs to the low-income group opt for Government based health insurance plans, the Government of India has been taking numerous initiatives in this field to ensure hassle-free access to medical facilities by the economically weaker sections.
Let us have a look at some of the major Health Insurance Schemes under the supervision of the Government of India.
1. Rashtriya Swasthiya Bima Yojna (RSBY)
This scheme has been launched by the Government of India for providing health insurance to those families which are below the poverty line. The beneficiaries of the RSBY can avail of a hospitalization cover of up to Rs. 30,000. There is no waiting period and age barrier for availing the coverage for pre-existing diseases. The beneficiaries are issued with smart cards, and they can be used in any of RSBY authorized hospitals throughout the country. The treatment procedure under RSBY is cashless and paperless in nature and covers up to 5 members in a family, i.e. the policyholder, spouse and up to 3 children who are dependents.
2. Central Government Health Scheme (CGHS)
This scheme helps provide medical coverage to Central Government employees and pension holders along with their dependents who are living in the cities covered under CGHS. The scheme provides coverage for hospitalization expenses, domiciliary expense, consultation expense of specialists, X-Ray, ECG and other laboratory examinations, etc.
3. Employment State Insurance Scheme (ESIS)
The ESIS is applicable for employees belonging to non-seasonal factories that have employee strength of 10 persons or more. Coverage is provided for disablement (temporary or permanent) leading to loss of income, cash benefits during sickness, complete medical care, etc. This scheme applies to hotels, shops, cinemas, educational institutions, etc. which employ around 20 persons or more.
4. Aam Aadmi Bima Yojna (AABY)
This scheme is meant for those households which are landless in the rural regions of India. One member is covered from each household, and he should be within the age bracket of 18 years to 59 years. On the death of the person insured naturally, an amount of Rs. 30,000 can be claimed by the family. Moreover, an amount of Rs. 75,000 and an amount of Rs. 37,500 can be claimed by the family of the insured person in case of death or permanent disability due to accident and partial disability, respectively.
5. Janashree Bima Yojna (JBY)
JBY scheme provides health insurance coverage for individuals aged between 18 years to 59 years and belonging to below poverty line. There are 45 occupational groups such as Carpenters, Cobblers, Lady Tailors, Agriculturists, Forest Workers, etc. covered under this scheme.
In addition to these health insurance schemes backed by the Government, there are some other additional health insurance plans such as Micro-health Insurance, Yeshasvini Scheme and the Universal Health Scheme launched by the Government of India. These schemes help in providing health insurance services and surgery facilities to the poor people easily with modest premium levels.
Hence, along with the Government-funded schemes, many NGOs are also putting in a lot of effort for making easy health care facilities available to the poor sections of the society. With these new health insurance plans and programs, it is hopeful that good health care facilities will no longer be a distant dream for the low-income groups in India and they would be able to enjoy the health care services conveniently without much hassle.
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