Eleventh Five Year Plan

Health and Family Welfare and AYUSH 83public or private-for-profit insurance schemes is thatthe targeted community is involved in defining thecontribution amount and collecting mechanism, contentof benefit package, and allocating the scheme’sfinancial resources.3.1.94 CBHI schemes in India are very diverse innature in terms of design, management, and size ofthe targeted population. ACCORD, BAIF, KarunaTrust, Self Employed Women’s Association (SEWA),DHAN Foundation, and VHS are some examples.Experience of current CBHI schemes in India revealsthat area specific schemes should be developed accordingto the local requirements. These schemes shouldbe tailored to the reality of the poor, and organizedaccording to their convenience. During the Plan, CBHIschemes through the public system and by accreditedprivate providers will be encouraged.HEALTH INSURANCE FOR THE UNORGANIZED SECTOR3.1.95 We have a huge working population of about400 million. Almost 93% of this work force is in theunorganized sector. There are numerous occupationalgroups in economic activities, passed on from generationto generation, scattered all over the country withdiffering employer–employee relationship. Those inthe organized sector of the economy, whether in thepublic or private sector, have access to some formof health service coverage. The unorganized sectorworkers have no access. The National Commissionfor Enterprises in the Unorganized Sector (NCEUS)has recommended a specific scheme for health inincidences of illness and hospitalization for workersand their families.3.1.96 The Eleventh Five Year Plan will introduce anew scheme based on cashless transaction with theobjective of improving access to health care and protectingthe individual and her family from exorbitantout-of-pocket expenses. Under the scheme, coveragewill be given to the beneficiary and her family of fivemembers. Providers will be both public and private.MATERNITY HEALTH INSURANCE3.1.97 During the Eleventh Five Year Plan, the MaternityHealth Insurance Scheme as an initiative across afew States is expected to be implemented. This schemeis premised on capitation-based financing, where theprovider is assured a fixed per capita payment in respectof all those who enrol for maternity care. All pregnantwomen belonging to BPL families will be coveredunder this scheme. They would register with the ANMand simultaneously identify from a list of diverse accreditedproviders, any institutional facility in the publicor private sector, which will look after her duringher pregnancy. The ANM will complete the antenatalcheck in consultation with the facility identified. Thecapitation fee for the pregnant women in the BPLcategory will be borne by government. This interventionwill improve outcomes for maternal and infantmortality by ensuring that the complete cycle of maternitycare in particular for the poor, is handled by aqualified institutional provider. More specifically, thisintervention will increase institutional deliveries andlower maternal mortality, empower women withimproved access to reproductive health care, enableand facilitate women to adopt postpartum terminalmethods of family planning if they need to. It willstimulate development of accredited health infrastructureaccessible in rural and remote areas, facilitate partnerships,and finally, improve the responsiveness andaccountability of public sector facilities.Central Government Health Scheme (CGHS)3.1.98 CGHS was started in 1954 and at present 24cities are covered with total of 9.12 lakh card holdersand 33.01 lakh beneficiaries (as on 31 March 2006).72.5% card holders are serving employees, 25.4%are pensioners, and rest belong to the categories suchas freedom fighters, Members of Parliament (MPs), ex-MPs, journalists, and others. Services covered underCGHS include hospitalization, outpatient consultationand treatment, diagnostics, drugs, etc. For these servicesthere are 247 allopathic dispensaries, 82 AYUSHdispensaries, 19 polyclinics, and 65 laboratories in thecities covered. For hospitalization, the services arelargely outsourced to selected private hospitals, allgovernment hospitals are included. Out PatientDepartment (OPD) and diagnostic services are alsopartly outsourced to selected private hospitals anddiagnostic centres.3.1.99 Mid Term Appraisal for the Tenth Plan has madethe following recommendations regarding CGHS: