Penetration and coverage of government-funded health insurance schemes in India

This paper presents the historical evolution, financing, depth and coverage, and implementation status of the currently promoted government-funded health insurance (GFHI) schemes across the socioeconomic stratum, districts, and states. The study uses official and large scale survey data, namely India Human Development Survey 2012, National Family and Health Survey 2016 and National Sample Survey 75th round on health 2019. The official data claim that around 109 million families are covered under existing GFHIs by 2017-18, while estimates from survey data do not substantiate it. The actual coverage reported by the households in survey is found 68.2% less than the claim made by the governments in official data. The size of coverage of GFHIs however makes them world's largest pro-poor health insurance schemes. The coverage amount ranges from Rs 30,000/family under Rashtriya Swasthya Bima Yojana to as high as Rs 3,30,000/family under Bhamashah Swasthya Bima Yojana, Rajasthan, and Rs 5,00,000/family under Pradhan Mantri Jan Aarogya Yojana. The penetration of various scheme is recorded high among non-poor and urban as compared to their other counterparts with a wide variation across states/districts, posing serious challenge for ensuring equitable access to healthcare to the general population. The contribution of insurance in financing total health expenditure is increasing, but has substantially low share, it is the households OOP (out-of-pocket) that still constitute the higher share in financing health expenditure.