GOVERNMENT SPONSORED HEALTH INSURANCE SCHEMES FOR REIMBURSEMENT OF CANCER TREATMENT IN INDIA

Author(s)

Singh S, Rai MK, Bhutani MK, Singh R, Gollala M, Rana P
Tata Consultancy Services, Mumbai, India

OBJECTIVES: Various estimates by World Health Organization (WHO) and other authorities suggest that incidence of various types of cancers in India is on rise. As cancer treatment is costly, health insurance can save significant financial burden on cancer patients and their families. The purpose of this research is to identify major government sponsored schemes for reimbursement of cancer treatment in India and population coverage under such schemes. METHODS: Secondary research was conducted to analyze the relevant information from government websites, review articles, research articles, World Bank reports and special task force reports. An overall summary pertaining to reimbursement entitlement under different schemes was prepared and analysed. RESULTS: Major government sponsored health insurance schemes that together cover 82 million government employees for reimbursement of cancer treatment in India, include, Central Government Health Service (CGHS), Employee State Insurance Scheme (ESIS), Retired Employees Liberalized Health Scheme (RELHS), railway health service and Ex-servicemen Contributory Health Scheme (ECHS). Entitlements under above mentioned schemes are comprehensive and include reimbursement for primary, secondary and tertiary medical care including outpatient charges, medicines, special diagnostics and lab-based tests. There is no per-capita limit on expenditure under these schemes. For poor population, central government funds Rashtriya Swasthya Bima Yojana (RSBY) to insure 70 million Below Poverty Line (BPL) families for hospitalization related expenses of up to INR 30,000. Aarogyasri, Kalaignar and Yeshasvini are some of the state-sponsored schemes that cover state specific 114 million BPL population for hospitalization related expenses in the range of INR 1,00,000-1,50,000.  CONCLUSIONS: Together these schemes cover almost 266 million people and protect them from catastrophic expenditure of cancer treatment. However, there is a large amount of population that remains uncovered. It is also important to increase the provisions under state-sponsored schemes and RSBY as they do not provide comprehensive coverage for cancer treatment.

Conference/Value in Health Info

2016-09, ISPOR Asia Pacific 2016, Singapore

Value in Health, Vol. 19, No. 7 (November 2016)

Code

PCN58

Topic

Health Policy & Regulatory

Topic Subcategory

Reimbursement & Access Policy

Disease

Oncology

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