Eleventh Five Year Plan

Health and Family Welfare and AYUSH 105impoverishment. CBHI initiatives based on someindividual contribution to the premium, along witha government subsidy, will be supported as theywould improve the health care quality and expandinterventions as per need of the people. In the EleventhFive Year Plan we will consider approachessuch as comprehensive risk pooling packages throughthe public system and through accredited privateproviders. This is an area where many experimentsneed to be encouraged to discover what can work bestfor people.HEALTH SPENDING3.1.192 Health spending in India is estimated to bein the range of 4.5–6% of GDP. The results from theNational Health Account (NHA) for the year 2001–02(Figure 3.1.15) showed that total health expenditurein the country was Rs 105734 crore, accounting for4.6% of its GDP. Out of this, public health expenditureconstituted Rs 21439 crore (0.94%), private healthexpenditure constituted Rs 81810 crore (3.58%) andexternal support 2485 crore (0.11%).3.1.193 Of the private health expenditure during2001–02, households’ out-of-pocket health expenditurewas Rs 76094 crore, which accounts for 72% ofthe total health expenditure incurred in India. Thisincludes out-of-pocket payments borne by the householdsfor treating illness among any member inthe household and also insurance premium contributedby individuals for enrolling themselves or familymembers in health insurance schemes. The data showsthat a majority of expenditure (87.7%) goes towardscurative care.3.1.194 Studies have shown that the poor and otherdisadvantaged groups in both rural and urban areasspent a higher proportion of their income on healthcare than those who are better-off. The burden of treatmentis high on them when seeking inpatient care(NSSO 60th Round). Very often they have to borrowat very high interest to meet both medical and otherhousehold consumption needs. The Eleventh Five YearPlan will explore mechanisms for providing universalcoverage of population for meeting the cost of hospitalization,particularly for those who cannot afford it.It will provide public-sector financed universal healthinsurance, for which private and public-sector providerorganizations can compete.TREND IN HEALTH FINANCING BY THE CENTREAND STATES3.1.195 The financial allocation for the health sectorover the past decade indicates that the public expen-Box 3.1.21Some Innovative Financing MechanismsKerala:Uttar Pradesh:Jharkhand:Haryana:Karnataka:In Kozhikode, risk pools constituted around professionals or occupational groups, SHGs ormicro credit groups, weavers, fishermen, farmers, agricultural labourers, and other informal groups. Almost90% of the population is covered under some form of network or the other.Voucher scheme for RCH services piloted in seven blocks of Agra for BPL population. The scheme waslaunched in March 2007 and funded by State Innovations in Family Planning Services Agency.In order to promote institutional delivery and routine immunization, a voucher scheme was introduced inDecember 2005 in all 22 districts. Vouchers are issued to BPL pregnant women at the time registration ofpregnancy. She is entitled to have the delivery at any government facility or at accredited private healthproviders.Vikalp—an innovative approach to financing urban primary health care for the poor through a combinationof PPPs and risk pooling using capitation fees for a package of primary health care services with theState Health Department and private providers.Yeshasvini Co-operative Health Care Scheme is a health insurance scheme targeted to benefit the poor. Thescheme was initiated by Narayana Hrudayalaya, a super-specialty heart-hospital in Bangalore and by theDepartment of Co-operatives of the Government of Karnataka. All farmers who have been members of acooperative society for at least a year are eligible to participate, regardless of their medical histories. Thescheme provides coverage for all major surgeries.