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 Table of Contents  
REVIEW ARTICLE
Year : 2018  |  Volume : 10  |  Issue : 1  |  Page : 45-49

Utilization of health-care schemes: A ground reality of Indian scenario


1 Department of Public Health Dentistry, Surendera Dental College and Research Institute, Sri Ganganagar, Rajasthan, India
2 Department of Prosthodontics, BJS Dental College, Ludhiana, Punjab, India
3 Department of Public Health Dentistry, Dr. D. Y. Patil Dental College and Hospital, Pune, Maharashtra, India

Date of Web Publication2-Feb-2018

Correspondence Address:
Aditi Sharma
Department of Public Health Dentistry, Surendera Dental College and Research Institute, Sri Ganganagar, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jorr.jorr_40_17

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  Abstract 

Health-care system in a society must be built around the term of equity so that each individual should have equal opportunities for maintaining good health, but human societies are characterized by unevenness at every aspect, and it has even not spared the health-care system. Despite great improvements in the oral health status of population across the world, health problems continue to be a major public health concern. India's health system faces the ongoing challenge of responding to the needs of the most disadvantaged groups of the society. Thus, to reduce inequalities in health and ensuring equity in oral health care, India as one of the developing countries in the world have taken steps at center as well as state level to bridge the gap between poor and rich in terms of health care. These schemes are built to touch the lives of the remotest people in the country. The government is boosting its strategies and augmenting its reach mechanisms to ensure that not a soul is dispossessed of any benefits, which arise from the virtue of this scheme. The present review concludes that though these schemes appear to be pro-poor and are inclusive of disadvantaged minorities, the scheme suffers from adverse selection. These schemes have the potential to play an important role in India's move toward universal health coverage.

Keywords: Challenges, health-care schemes, impact


How to cite this article:
Sharma A, Oberoi N, Singh S, Mathur A, Aggarwal VP, Batra M. Utilization of health-care schemes: A ground reality of Indian scenario. J Oral Res Rev 2018;10:45-9

How to cite this URL:
Sharma A, Oberoi N, Singh S, Mathur A, Aggarwal VP, Batra M. Utilization of health-care schemes: A ground reality of Indian scenario. J Oral Res Rev [serial online] 2018 [cited 2019 Oct 14];10:45-9. Available from: http://www.jorr.org/text.asp?2018/10/1/45/224542


  Introduction Top


Health-care system in a society must be built around the term of equity so that each individual should have equal opportunities for maintaining good health, but human societies are characterized by unevenness at every aspect, and it has even not spared the health-care system.

Health disparity in a population is proposed to exist when there is a significant disparity reported in the overall rate of disease incidence, prevalence, morbidity, mortality, or survival rates in the population as compared to the health status of the healthy people from the same population.[1] Previous literature suggests social factors outside the health domain as the root of much of the inequalities in health that we observe within and between countries.

Few of the common disparities of social architecture are based on gender, cast, and social hierarchy. In human society, there is an unequal distribution of privileges across the strata. In simple words, the layers of a society are ranked. Those occupying higher positions are more privileged than those who occupy lower position. Therefore, social stratification may be patterned as social inequality. Stratification is usually based on three major premises, i.e., power, prestige, and wealth.[2],[3]

Social inequality unlike stratification is not only evident between groups in terms of the amount of power, wealth, and prestige their members possess but also between members of different gender [4],[5],[6] and age groups.[7] Here, it may be noted that the inequality between men and women or between different age groups is not regarded as social stratification. Hence, we may say that social stratification deals with social inequality but not with all types of social inequality. Likewise, health inequalities are not confined to differences between rich and poor, health follows a social gradient. Higher the position in the social hierarchy, lower the risk of ill health. The poor and underprivileged people have a higher risk of disease and suffer from worse health conditions. For people living below poverty line (BPL), a disease is not only a permanent risk to their income-earning capacity, but also in many cases, it leads to the family sinking into a debt trap.

Despite great improvements in the oral health status of population across the world, oral health continues to be a major public health concern.[8] Oral diseases make significant contributions to the global burden of disease, which is particularly high in underprivileged groups in both developed and developing countries. Poor living conditions, unhealthy lifestyles, and limited availability as well as access to prevention-oriented oral health services represent the major risk to oral health.

India's health system faces the ongoing challenge of responding to the needs of the most disadvantaged groups of the society. Thus, to reduce inequalities in health and ensuring equity in oral health care, India as one of the developing countries in the world has taken steps such as Rashtriya Swasthya Bima Yojana (RSBY), Bhamashah Swasthya Bima Yojana (BSBY), Mukhya Mantri State Health Care Scheme (MMSHCS), and Bhai Ghanhya Sehat Sewa Scheme (BGSSS) at center as well as state level to bridge the gap between poor and rich in terms of health care. This review is intended to focus on various positive steps taken by center and State Government of India and mention its impact on overall health of poor masses so that conclusive evidence can be pointed out from such steps in terms of social inequality.


  Current Indian Scenario Top


The status of oral health care in India has not yet received the due importance. During the past 60 years of independence, medical sciences have made tremendous progress in battling most of the communicable and noncommunicable diseases. Despite that it has been proved that oral health has a direct effect on the general health,[8] still, oral health care has been neglected. Currently, different types of health schemes are running in our country to combat the social inequalities toward oral health which are as follows.

Rashtriya Swasthya Bima Yojana

Genesis of Rashtriya Swasthya Bima Yojana

RSBY [9] has been launched in 2008 by Ministry of Labor and Employment, Government of India, to provide health insurance coverage for BPL families in 26 states and union territories. RSBY [9] was initially designed to target only the BPL households but has recently been expanded to cover a number of non-BPL categories of informal sector workers, including street vendors, domestic workers, bidi workers, building and construction workers, and most importantly the workers who have worked for more than 15 days under daily wage scheme.[9]

Benefits/advantages

The Government of India and the state government are co-financing the premium cost for enrolled beneficiaries. Its service delivery model (comprises demand financing, freedom of choice among accredited government and private hospitals, and cashless service reimbursable to provider on a predetermined package price basis) could become a strong pillar for the universal health-care system laid down by the Government of India. The objective of RSBY is to provide protection to BPL households from financial liabilities arising out of health shocks that involve hospitalization. The beneficiaries under RSBY [9] are entitled to hospitalization coverage up to Indian rupees (INR) 30,000 for most of the diseases that require hospitalization. The coverage extends to five members of the family which includes the head of household, spouse, and up to three dependents. The beneficiaries need to pay only INR 30 as registration fee while central and state government pays the premium to the insurer selected by the state government on the basis of a competitive bidding.

Finance

Majority of the funding comes from central government, i.e., 75% of premium is paid by central government while remaining 25% of premium is paid by state government (number changes to 90% and 10% in case of northeastern states and Jammu and Kashmir). As of now, the scheme is operational in 398 districts of 25 states. There are 10,116 hospitals empaneled across these states out of which 5941 are private sector hospitals and 4175 are public sector hospitals. During the fiscal year 2013–2014, approximately 2.5 crore families were in possession of active RSBY cards.[9]

Coverage

The program has the target to cover 70 million households by the end of the 12th 5-year plan (2012–2017). As per the National Sample Survey Office report of the 68th round for the year 2011–2012, there are 2166.58 lakh and 531.25 lakh individuals BPL staying in rural and urban areas, respectively.[9]

Bhamashah Swasthya Bima Yojana

Genesis of Bhamashah Swasthya Bima Yojana

This health scheme was envisaged by the Government of Rajasthan in the year 2014–2015 with the aim to offer inpatient department patients with access to cashless facility.[10] The premium payments for each family are fixed and must be made on an annual basis on floater policy. BSBY [10] offers benefits to beneficiaries of the National Food Security Scheme and beneficiaries of the RSBY.[9] The scheme is expected to be implemented through Bhamashah cards. However, identity related to RSBY [9] and the National Food Security Scheme must also be honored until the issuance of Bhamashah cards.[10]

Benefits/advantages

Following are the key benefits offered by BSBY:[10]

  • In-house claims processing software and standardized and transparent grading criteria for hospitals
  • Verified and well-defined medical protocols
  • Mobile application for the monitoring of all government officials in the district
  • Removal of third-party administrator and effective monitoring mechanism for the prevention of cost escalation and leakages
  • Opportunity for poor people to approach private health institutions for health services
  • Financial improvement of Medicare Relief Societies of Government Health Institutions.


Finance

BSBY gives health insurance cover for general illnesses of INR 30,000, critical illness cover of INR 3 lakhs, and transport allowance for trauma and cardiac cases of INR 100–500.

Coverage

As of now, free health care is provided to more than 11.25 lakh people and around 4.5 crore individuals are covered under this scheme.[10]

Mukhya Mantri State Health Care Scheme

Genesis of Mukhya Mantri State Health Care Scheme

This scheme was launched by the Government of Himachal Pradesh in the year 2016 for those who are not enrolled under RSBY or other medical reimbursement scheme.[11] The state had targeted most vulnerable population to provide health coverage under MMSHCS.

Benefits/advantages

The scheme mainly covers 9 categories which are senior citizens (80 years and above), ekal naris, more than 70% disabled persons, contractual employees, part-time workers, daily wage workers, anganwadi workers, anganwadi helpers, and mid-day meal workers. The benefits include INR 30,000/year on family floater bases under “basic package” only in case of hospitalization (indoor treatment and daycare). In all 173 hospitals which are empaneled under RSBY.[9] In case of critical illness, INR 175,000/year on family floater basis under “critical care package” offered at the selected hospitals.[11]

Coverage

The estimated beneficiaries of the scheme will be more than 200,000 families.

Bhai Ghanhya Sehat Sewa Scheme

Genesis of Bhai Ghanhya Sehat Sewa Scheme

Bhai Ghanhya Sehat Sewa Scheme [12] was launched in the state of Punjab to make equitable, affordable, and quality health-care accessible to the farmers and others comprising most vulnerable section of the society.

Benefits/advantages

Every beneficiary is entitled to a cashless treatment up to INR 1.5 lakhs on family floater basis in any approved hospital and on re-imbursement basis in any government hospital in Punjab and Chandigarh after submitting the claim within 45 days from the date of discharge from the hospital. Each member and employee of any cooperative society in the state was eligible for enrollment under the scheme.[12]

Coverage

Nearly 85,000 beneficiaries have availed treatment worth INR 109 crore during the previous four policy plan periods.[12]

Bhagat Puran Singh Sehat Bima Yojana

Genesis of Bhagat Puran Singh Sehat Bima Yojana

The Government of Punjab launched a smart card-based cashless health insurance scheme covering those families of Punjab which were covered under the coveted Atta Dal Scheme of the Government of Punjab.[13] The estimated number of such families in Punjab is 15.4 lakhs.

Benefits/advantages

This scheme provides compensation of INR 30,000 per family per year to the enrolled families for medical or surgical procedures in government and private hospitals and nursing homes. The benefit to the family will be on floater basis, i.e., the total reimbursement of INR 30,000 can be availed of individually or collectively by members of the family per year.[13]

Finance

Government has appointed United India Insurance Company Limited and United India Insurance Co., Ltd., to provide insurance cover for the Bhagat Puran Singh Sehat Bima Yojana.[13]

Mukhyamantri Swasthya Bima Yojana

Genesis of Mukhyamantri Swasthya Bima Yojana

Mukhyamantri Swasthya Bima Yojana [14] (MSBY) was launched by Hon Chief Minister of Uttarakhand in 2016. The scheme was initially designed for a period of 6 months and has been given an extension of 2 months.

Benefits/advantages

Under the scheme, all those families of the state, who are resident of the state, are eligible to be covered except nuclear families of and dependents of government servants, pensioners, and income tax payers. A base cover of INR 50,000 covering 1206 diseases and critical cover package of INR 125,000 covering 458 diseases is provided to the individuals.[14]

Coverage

Till now, around 1,359,817 individuals are benefitted under this scheme.

Rajiv Aarogyasri Scheme

Genesis

This scheme was launched by the Government of Andhra Pradesh in 2007 for financing health care of persons living BPL, especially for the treatment of serious ailments such as cancer, kidney failure, and heart diseases. It was initially launched as a pilot project in three most backward districts of the state, namely, Anantapur, Mahaboobnagar, and Srikakulam and later extended to all the districts of the state.[15]

Benefits/advantages

Coverage was given for 163 treatments including those for heart, cancer, neurosurgery, renal procedure, burn, and polytrauma cases. The scheme shall provide coverage for the services to the beneficiaries up to INR 1.50 lakhs per family per annum on floater basis and 0.50 lakhs through buffer; thus, total coverage is INR 2 lakhs.[15]

Coverage

Rajiv Aarogyasri [15] is being implemented by Aarogyasri Health Care Trust in the state to assist 233 lakh poor families. Around 2,319,731 patients are registered under this scheme.[15]

Vajpayee Arogyashree Scheme

Genesis

To improve access of BPL families toward quality tertiary medical care for treatment of identified diseases involving hospitalization, surgery, and therapies through an identified network of health-care providers, the Government of Karnataka launched Vajpayee Arogyashree Scheme in 2010.[16]

Benefits/advantages

The benefit package will cover tertiary care for catastrophic diseases. Sum assured will be INR 150,000 on a family floater basis per year. Additional buffer of INR 50,000/year for the entire family on a case to case basis (if the total expenditure exceeds more than INR 150,000) will be provided. The benefit availed by the family will be on a floater basis for a total reimbursement of INR 150,000/- which can be availed individually or collectively by members of the family.[16]

Coverage

More than 9 lakh BPL families are benefitted under this scheme till date.[16]


  Impact of These Health Schemes Top


According to a study conducted by Sinha and Chatterjee,[17] there is a changing trend seen in the monthly per capita expenditure of health in different states as compared to the previous records. The institutional expense had increased slightly in the states of Bihar, Gujarat, Kerala, and Uttar Pradesh while it had decreased in states such as Chhattisgarh, Himachal Pradesh, Jharkhand, Punjab, Uttarakhand, and West Bengal. In Haryana, the monthly per capita institutional expense did not show much variation in these periods. As of now, in the state of Rajasthan through 949,775 transactions, INR 5,475,434,858 is spent to provide quality health care to the underprivileged people.[10] Till December 2016, 7.4 lakh claims of 351 crores have already been settled and 6.72 lakh patients have been treated under this scheme. In the state of Uttarakhand, 33,170 claims were reported and INR 268,728,408 is spent on medical care to benefit the poor and needy under the MSBY Scheme.[14] Under Vajpayee Arogyashree Scheme in Karnataka, INR 22.95 crore was released to different hospitals for treatment of disadvantaged individuals.[16] As a matter of fact till June 2014 under Rajiv Aarogyasri Scheme in Andhra Pradesh, a total of 2,319,731 patients were registered. A total of INR 2170.56 crores were spent on the treatment of the underprivileged people, and of the total amount, INR 1525.50 crores were expended by the government for the treatment of people in private hospitals.[15] This could imply that the benefits of these schemes were yet to reach such states where the monthly per capita institutional expenses had either decreased or remained unchanged.


  Disadvantages of Health Schemes Top


  • It has been observed that the hospitals demanded out-of-pocket expenses to initiate treatment for these beneficiaries which has ultimately led to low utilization of the scheme
  • Low level of awareness about the health schemes
  • Availability of little data on treatment outcomes
  • Reports of fraud and medical malpractice.[18]



  Challenges/barriers Top


There are certain states in the country such as Jammu and Kashmir, Goa, and Nagaland where these health-care schemes are not yet launched, thus affecting the utilization of health care by the neglected population. Moreover, in relation to dentistry, very few private dental clinics are registered under these schemes where the maximum oral health-care services are provided. The reason might be very low prices provided by the government for each dental treatment. For example, the cost provided by the Government for root canal treatment (RCT) of each tooth is INR 500 which is very less as compared to the usual fees charged by the dentists.[10] Therefore, the government has to reconsider the package for the dental treatments so that more private dental clinics get enrolled under these schemes, and a maximum number of people get benefitted, thus reducing the prevalence oral health diseases. Some other challenges for the less utilization of these schemes are illiteracy, lack of awareness, and lack of proper campaigning of these schemes.


  Conclusion Top


These schemes are touching lives of the remotest people in the country. A plethora of campaigns and efforts have been and will be directed to raise awareness about the scheme so that every nook and corner is abreast of the scheme and the numerous benefits it renders. The government is boosting its strategies and augmenting its reach mechanisms to ensure that not a soul is dispossessed of any benefits, which arise from the virtue of this scheme. This review concludes that though these schemes appear to be pro-poor and are inclusive of disadvantaged minorities, the scheme suffers from adverse selection. These schemes have the potential to play an important role in India's move toward universal health coverage. To do this, however, scheme awareness should be increased; targeting mechanisms warrant improvement and ensure that participation leads to cashless care. The differences in the effectiveness between various states suggest that regulatory and infrastructural reform may lead to more effective coverage.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Jacobs E. The Minority Health and Health Disparities Research and Education Act of 2000. SGIM Forum 2001;24:6-9.  Back to cited text no. 1
    
2.
Doda Z. Introduction to Sociology. Social Stratification. Ethiopia: Debub University Press; 2005. p. 167-76.  Back to cited text no. 2
    
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Cragun R, Cragun D. Stratification. Introduction to Sociology. Denmark: Blacksleet River; 2006. p. 159-67.  Back to cited text no. 3
    
4.
Brinton MC. The social institutional bases of gender stratification: Japan as an illustrative case. Am J Sociol 1988;94:300-34.  Back to cited text no. 4
    
5.
Anthias F. The material and the symbolic in theorizing social stratification: Issues of gender, ethnicity and class. Br J Sociol 2001;52:367-90.  Back to cited text no. 5
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Berdahl JL. Harassment based on sex: Protecting social status in the context of gender hierarchy. Acad Manage Rev 2007;32:641-58.  Back to cited text no. 6
    
7.
House JS, Lepkowski JM, Kinney AM, Mero RP, Kessler RC, Herzog AR, et al. The social stratification of aging and health. J Health Soc Behav 1994;35:213-34.  Back to cited text no. 7
    
8.
Petersen PE, Bourgeois D, Ogawa H, Estupinan-Day S, Ndiaye C. The global burden of oral diseases and risks to oral health. Bull World Health Organ 2005;83:661-9.  Back to cited text no. 8
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9.
Available from: http://www.rsby.gov.in. [Last accessed on 2017 June 22].  Back to cited text no. 9
    
10.
Available from: http://www.rajswasthya.nic.in/bsby.htm. [Last accessed on 2017 June 22].  Back to cited text no. 10
    
11.
Available from: https://www.myhealthcareindia.com/mukhya-mantri-state-health-care-scheme-hp.html. [Last accessed on 2017 June 22].  Back to cited text no. 11
    
12.
Available from: http://www.mdindiaonline.com/bgsss/BGSMain.aspx. [Last accessed on 2017 June 22].  Back to cited text no. 12
    
13.
Available from: http://www.pbnrhm.org/bpssby_enrollment_schedule.aspx. [Last accessed on 2017 June 22].  Back to cited text no. 13
    
14.
Available from: http://www.msbyukh.co.in. [Last accessed on 2017 June 22].  Back to cited text no. 14
    
15.
Available from: http://www.aarogyasri.telangana.gov.in. [Last accessed on 2017 June 22].  Back to cited text no. 15
    
16.
Available from: http://www.sast.gov.in/home/details. [Last accessed on 2017 June 22].  Back to cited text no. 16
    
17.
Sinha RK, Chatterjee K. Assessing impact of India's National Health Insurance Scheme (RSBY): Is there any evidence of increased health care utilization? Int J Hum Soc Sci 2014;4:223-32.  Back to cited text no. 17
    
18.
Available from: http://www.rsby.gov.in/Docs/RSBY%20Committee%20Final%20Draft%20Report%20for%20Comments.pdf. [Last accessed on 2017 Dec 04].  Back to cited text no. 18
    



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