Page 180 - India Insurance Report 2023- BIMTECH

168 India Insurance Report - Series II

to ill-health. However, what many employers do is that they do not even register most of their employees
and easily wriggle out of these expenses. And the eligible workers remain completely unaware of their
lawful right to free healthcare!

The CGHS is one of the oldest schemes which provides comprehensive health coverage for Central
Government employees, pensioners and their families in varied cities across India. However, there is a
notorious delay in reimbursements to the empanelled hospitals and a lack of proper oversight, which
increases the susceptibility to fraud.
Therefore, while the varied government interventions do ease the burden of healthcare costs on the
underprivileged to some extent, it is a sad fact that around 70% of the healthcare expenses continue to be
out of pocket. To put a number on it, as per WHO estimates in 2017, the out-of-pocket expenditure in
India as a proportion of total health expenditure stands as one of the highest in the world at 62.4%. A
whopping disparity against the global average of only 20.5%.

The reasons for the measly outcome are quite varied. Many of the public health initiatives exhibit a
low enrolment simply because many of the eligible people just don’t know about them. A ubiquitous
loophole is that hardly any of the schemes cover outpatient services – these happen to be the most
common medical intervention. Moreover, the poor population usually prefers outpatient consultations
as the workers want to avoid missing work on account of hospitalization. Especially when it comes to
chronic conditions, the high medical costs of medical consultations can play havoc with their finances.

Even when they have no choice but to get admitted for advanced medical treatment, many of the
hospitals simply turn the beneficiaries away or provide shoddy treatment at best. This is compounded
by the fact that the facilities in public hospitals are so inferior that the poor are left with no option but
to go to another hospital and foot the heavy bill by themselves.

Again, government healthcare mostly disregards the temporary workers and the unorganized sector
– these sections of the populace cannot register for these schemes and miss out on the rudimentary
health coverage. And what about the unfortunate middle class who continue to be blindly overlooked
by the policymakers’ rights since Independence? Don’t they need financial risk protection against
unforeseen medical expenditures? The fact is that an unexpected health catastrophe can unleash a
debilitating panic for the middle-income segment as well. The heavy blow on their finances often drives
them into indebtedness and potential impoverishment. So much so that, every year, approximately 7%
of the population sinks below the poverty threshold while scrambling to cover their healthcare costs!

The path of UHC needs to be lined with a comprehensive plan for extending complete healthcare
facilities to the vulnerable sections of society. Health being a state subject, the state governments have to
ramp up and coordinate with the Centre to provide inclusive healthcare to all.
The public health expenditure in India was mostly stagnant at a marginal 1% of the GDP and has
recently witnessed a progressive increase to around 1.4%. The government now plans to scale it up to
2.5% by 2025. However, a robust budgetary increase to at least 5% is vital today. This may sound
overblown and fanciful, but consider that the world average stands at 6%. Moreover, most of the developed
and even developing countries have managed to achieve universal health coverage by way of considerable
budgetary allocations.