Page 38 - The Insurance Times October 2024

grams in the world. Officially known as the Pradhan Mantri Impact: Thailand's UCS has dramatically improved access to
Jan Arogya Yojana (PM-JAY), it aims to provide health cov- healthcare services for low-income populations. According
erage to more than 500 million people, specifically target- to a report by the WHO, the program has helped reduce
ing poor and vulnerable families. The scheme offers insur- the financial barriers to healthcare and has been effective
ance coverage of up to INR 5 lakhs (around USD 6,000) per in reducing health-related poverty. The UCS provides cover-
family per year for secondary and tertiary care hospitaliza- age for a wide range of services, including inpatient and
tion across public and private hospitals. outpatient care, maternity services, and preventive health
programs. As a result, Thailand has achieved near-universal
Impact: By 2024, Ayushman Bharat has made significant health coverage, with over 99% of its population insured.
strides in improving healthcare access for low-income popu-
lations in India. As of the latest data, over 220 million indi- While the UCS has been lauded for its inclusivity, challenges
viduals have received health cards under the scheme, and remain in terms of funding and the sustainability of the pro-
millions of hospital admissions have been covered without gram. The increasing demand for healthcare services has
any out-of-pocket expenses. The program has reduced the placed significant pressure on Thailand's public health sys-
financial burden of healthcare for many families, prevent- tem, raising concerns about the program's long-term finan-
ing medical costs from driving them into poverty. Moreover, cial viability.
it has helped improve the utilization of private healthcare
facilities by poor families, who previously lacked access due 3. Rwanda's Mutuelles de Santé
to high costs.
In Africa, Rwanda's Mutuelles de Santé (Community-Based
Health Insurance) program has been recognized as one of
However, Ayushman Bharat faces challenges in terms of the most successful inclusive health insurance models.
awareness and coverage gaps. Many eligible beneficiaries Launched in the early 2000s, the program is designed to
remain unaware of their entitlements, and some regions,
cover informal sector workers and low-income families
particularly rural areas, face difficulties in accessing the through a tiered premium structure, where households pay
necessary healthcare infrastructure.
premiums based on their income level. The program is
heavily subsidized by the government, ensuring that even
2. Thailand's Universal Coverage Scheme (UCS) the poorest households can access healthcare services.
Thailand is another country that has successfully imple-
mented a government-funded health insurance program to Impact: Mutuelles de Santé has significantly improved
provide universal healthcare. Launched in 2002, the Univer- healthcare access in Rwanda, particularly for rural popula-
sal Coverage Scheme (UCS) provides comprehensive tions. By 2024, over 90% of Rwanda's population is covered
healthcare services to all Thai citizens, including the poor under the program. The scheme has been credited with
and informal sector workers. The UCS is funded through reducing out-of-pocket healthcare expenditures, increasing
general tax revenues, and services are provided at public the use of health services, and improving overall health
health facilities without any out-of-pocket expenses. outcomes in the country.

Despite its success, the program faces challenges related
to financial sustainability. The premiums collected from low-
income households are not sufficient to cover the cost of
services, and the program relies heavily on government
subsidies and donor funding.

Scaling Inclusive Health Insurance: Les-
sons from Around the World

The success of these government-led programs provides
important lessons for scaling inclusive health insurance glo-
bally. Below are some of the key insights that can be ap-
plied to developing sustainable and scalable health insurance
models.

34 October 2024 The Insurance Times