'Health for all still a distant dream’

Health insurance cos finds fewer takers in JK

BILAL HUSSAIN

Health for all is still a distant dream in Jammu and Kashmir, with a large proportion of the population still unable to access quality health care. Health insurance products, which find not many takers in Kashmir have potential to realize the dream, experts in insurance sector here believe.
Financial experts are of the view that inability of the state health system to give affordable, accessible, and quality care to those who need it the most is due to undersized fund allocation by the state to the health sector.
The high out-of-pocket burden of health care continues to be a major issue, and injects further inequities into a system already plagued by access and quality concerns, which impact differentially on the population, says an analyst in insurance sectors. What is needed is to scale up social health insurance as well as stand-alone community health insurance schemes to achieve the dream of health for all, he proposes.
Insurance companies in both the private and public sectors should be involved in productive partnerships with the government, community based organizations in the endeavor to extend health coverage to the population, said a manager who works for a multinational insurance provider here.
Health insurance business in private as well as public sector has been increasing both in terms of premiums and numbers in the valley, however, most of the population in rural and urban areas is yet to be brought in the ambit of health coverage. “There is huge untapped market for the health insurance providers here,” said a local finance professional, Sovais Shafi.
Deliberating on the health insurance, Shafi said that mediclaim policy has undergone several structural changes and currently it is being offered in two major plans of individual and group policies. In group policy there is a feature of family floater where by paying a specified premium, all the family members of the employees can be covered. The sum insured or the coverage amount can be used for the principal insured or together for the family members.
However, Shafi seemed unsure as questions on whether and how households benefit from buying health insurance policies, what is needed is to analyze the premiums, sum insured and claims. “Case studies outside state have shown that most times health insurance policies have been beneficial for the households,” he asserts.
While citing examples of some prominent partnerships which include NGOs like Karuna Trust - Karnataka, SEWA - Gujarat, Student’s Health Home – Kolkata, Seba Hospital – Kolkata, Rag Picker’s Scheme – Pune, a local social worker said that these possible models could be replicated in J&K. There are other such partnerships as well, and the important point to note is that often these partnerships are beyond merely “public-private” but can be termed “private-private” or “public-public”, depending on who the stakeholders are.
Pertinently, as on June 30, 391 hospitals offered cashless mediclaim facility throughout India. Earlier, the state started health insurance scheme for the female sericulture workers of the State. The Insurance scheme was devised in collaboration with ICICI Lombard and in the first phase 1000 female sericulture workers were expected to be covered. As per the scheme, the covered worker was provided medical cover to the tune of Rs 15000 per year including medicines hospital expenses. There is dire need for such initiatives by the state and to include more people under health coverage, a local aid worker.