The hurdles ahead for universal health coverage

Going by recent evidence, attempts by the government to pass on some costs of the proposed National Health Protection Scheme—which aims to provide 100 million poor households with an annual health cover of Rs5 lakh each—to insurance companies or states may not go down well with either. The health portfolio of insurers comprises three categories: government- In 2016-17, of the Rs30,392 crore worth of premiums collected by health insurers, only 10% came from government- By expanding coverage to Rs5 lakh per household under the new scheme, in terms of coverage and premiums, the government will effectively move some part of this 77% bucket to the second group bucket. This is especially true for public sector insurers, who are the main supporters of RSBY and whose overall net incurred claim ratio has shot up from 103% in 2012-13 to 122% in 2016-17. Thus, if the centre were to ask insurers and states to share costs, it would have to come up with a construct that makes it worthwhile for them for benefits to truly reach 100 million vulnerable households.