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Financial Protection Schemes for the Poor

A key focus of the Institute’s work in the area of financing has been on financial protection schemes for the poor.  The Institute has carried out a number of studies to estimate quantum and contribution of different sources of funds for meeting health expenditure by people living below poverty line, to generate an evidence base for policy. Currently the Institute is carrying out a WHO funded study[1] for Government of India in three states- Orissa, MP and Maharashtra, to plan for financial protection of the poor under the NRHM. The study is based on primary surveys of clients of public hospitals (PHCs, secondary hospitals and medical colleges) and in-depth interviews of health managers, doctors and pharmacists. The study seeks to understand the basis for consumers incurring out of pocket expenditure on drugs, consumables and investigations for outpatient and in-patient care in public facilities; to study and document the nature of ailments for which consumers incur out of pocket expenditure; and to assess and estimate the quantum of expenditure incurred by consumers visiting public health care facilities across different levels of care.

As part of support to health sector reforms in West Bengal funded by the Indo-German Basic Health Project[2], the Institute has carried out a comparative study of health financing in developed countries that drew lessons on relevance of European social health insurance schemes to the Indian context. With support from the Madhya Pradesh Health department and the Ratlam District Administration, the Institute documented the Swablamby Swasthya Yojana (SSY) experience in Ratlam District. The SSY, a community based health insurance experiment was launched by the then Ratlam District Administration to find a solution for petitions from the poor and needy seeking assistance for treatment of serious illness. The scheme helps covered families access government hospital services for effective treatment, by providing drugs and therapeutics not available in the hospital. The key distinguishing feature of the scheme is its spontaneous appearance through the efforts of a creative district administration to meet a felt need of people[3].

The Institute was commissioned by the Ministry of Health and Family Welfare[4] to develop community health insurance based family health protection plans for consideration by the government of India . A benefit package which included comprehensive ambulatory primary care and access to first referral hospital services has been developed by the Institute. The plans would mostly use private clinics for the ambulatory care and public or nonprofit providers for hospital services. Minimum quality of service standard was recommended for clinics. The plans will provide better access to public hospitals and help improve their utilization. Nonprofit mutual health organizations are envisaged to underwrite the health care coverage risk and administer the plans. An income line for health and housing higher than the poverty line has been recommended, for purposes of administration of state financing of health insurance coverage to families.

[1] WHO India allotment: IND HSD 001 RB 06 (Sticker No. SE/07/116434), dt: 21/12/2006

[2] H&FW Dept. Govt. of West Bengal , Basic Health Project, dt. 31 Mar 2002; gtz PN97.2049.1-001.00

[3] IHS WP51/2003, Institute of Health Systems, Hyderabad , 2003

[4] Govt. Of India MOHFW DO No. N.23011/19/2000-Ply, dated 24 Jan. 2002, 30/3/2002, and 12 Jun. 2002





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