Eleventh Five Year Plan

82 Eleventh Five Year Planto develop a generic framework for different categoriesof PPPs at primary, secondary, and tertiary levelsof health care to improve cost-effectiveness, enhancequality, and expand access through extensive stakeholderconsultations. Contracting out well-specifiedand delimited projects such as immunization canhelp enhance accountability. Setting up of diagnosticand therapeutic centres (facilities that are not availablein hospital) by private players in hospital premiseswill be encouraged. Government may consider givingthem an infrastructure status in those geographicalareas by providing incentives like land at concessionalrates, increasing floor area ratio and groundcoverage, tax holiday, and loan at concessional rates.However, emphasis would be on model contractualagreements with specific performance requirementsto be measured by the civil society. Costs will bebuilt in.Health Insurance: Protecting the Poor3.1.88 In India, due to huge geographical area, verylarge population, and inequity of resources, ensuringgood health for all, particularly the poor, is a complexissue. Our health system is a mix of the public andprivate sectors, with the NGOs and civil society stillplaying a very small (though important) role.3.1.89 The 60th Round of the NSSO (2004–05), hasclearly brought out the fact that in rural governmenthospitals, an out-of-pocket expenditure of morethan Rs 3000 is made during every hospitalization. Inrural private hospitals, it is more than Rs 7000. Theexpenditure in the urban areas in private hospitals ismore than Rs 11000 and about three times higher thanthe public hospitals. Today, this expenditure wouldhave increased substantially. Private out-of-pocketexpenditure can be reduced through ComprehensiveHealth Insurance, on a risk pooling basis for all, particularlythe poor.3.1.90 Coverage of health insurance in India is patheticallylimited. Current health insurance in governmentand private sector covers around 11% of the population.The existing Employees State Insurance Scheme,Central Government Health Scheme (CGHS), andEx-Servicemen Contributory Health Scheme provideservices to industrial workers, government employees,and ex-Armed Forces Personnel along with theirfamilies. Mediclaim covers mainly the upper-middleincome groups. Private health insurance schemes aremainly urban oriented and they have problems likeunaffordable premiums, delay in settling claims, nontransparentprocedures in deciding reimbursements,etc. Even though the system of TPAs has facilitated cashpayments and expanded access to providers it is yet toshow evidence of having been able to control cost orprovide appropriate care.ENCOURAGE COMMUNITY RISK-POOLING3.1.91 Providing financial protection to the poorduring hospitalization will have an immediate impacton alleviating indebtedness. Local governments willidentify population at risk and provide a revolvingfund to be managed by a consortium of SHGs.This consortium would also encourage small savingsby households and whenever required, give needyhouseholds, a cash support of Rs 5000 to Rs 10000for hospitalization, catastrophic illness, and death.This will save households from immediate financialdebt at the point of crisis. They would repay thismoney at a modest interest rate within an appropriatetime frame so that the village health risk pool doesnot fall below Rs 1 lakh. During the Plan, pilots willbe undertaken in selected States under NRHM andNUHM. The scheme will empower SHGs, enablehouseholds to access micro-credit, and also recoverfrom financial stress during treatment of illness.COMMUNITY BASED HEALTH INSURANCE (CBHI)3.1.92 Evidence suggests that well-designed andmanaged CBHI schemes coupled with behaviouralchange campaigns and other interventions increase thequality of health care. Easy and low cost accessibilityto health care can protect the households from indebtednessarising from high medical expenditure. Theseschemes can be implemented in areas where institutionalcapacity is too weak to organize mandatorynation-wide risk pooling.3.1.93 CBHI is ‘any not-for-profit insurance schemethat is aimed primarily at the informal sectorand formed on the basis of a collective poolingof health risks and the members participating in itsmanagement’. What distinguishes these schemes from