The Rajasthan government has decided to provide health insurance to the 70 million residents in the state. The move comes after the government's decision to outsource primary health centres and specialised diagnostic services to private players on Public-Private Partnership (PPP) mode.
The Swasthya Bima Yojana scheme is provided under Chief Minister Vasundhara Raje's ambitious Bhamashah programme, through which the state is transferring benefits of its other schemes in the bank accounts of beneficiaries. The insurance scheme is likely to be launched in October.
Bhamashah is somewhat similar to the Union government-run Aadhaar or the Unique Identification Authority of India (UIDAI) scheme.
The only difference between the two systems is while the former is for each house-hold in Rajasthan with women being considered head of the family, the latter targets each resident in the country. Both are based on biometric authentication of the beneficiaries.
"The beneficiary of the ins-urance scheme can seek ben-efits between Rs 30,000 and Rs 300,000 in empanelled private hospitals," Rajasthan chief secretary CS Rajan tells Business Standard.
"We expect 70-80 per cent of the state population will benefit from the insurance scheme," adds Rajan.
Last week, the state government signed a memorandum of association with The New India Assurance Company with a rider that the latter cannot make more than 20 per cent profit from the premium paid.
The state government will bear the premium amount for families which are below poverty line and subsidise the rest of the population.
The beneficiaries can seek Rs 30,000 for general illness and Rs 300,000 for critical illness at district level hospitals.
The state officials say the sch-eme will ensure the poor in far-flung areas get better treatment in private hospitals, resulting in less load on the state hospitals. The Rajasthan government is grappling with shortage of doctors and other medical support staff.
"Introducing an insura-nce-based model of health care would mean compromising and sidelining to a great extent the immensely successful free medicines and free diagnostics schemes already operational in the state," says Chhaya Pachauli, senior programme manager at Rajasthan based non-profit organisation Centre For Health Equity.
"Health insurance schemes leave a lot of scope for patient exploitation and unethical practices especially by private impaneled health facilities. To increase the number of claims, there will be over medication and unnecessary surgical procedures by medical services facilities and patients will be subjected to unwarranted medical risks," she adds.
There have been reports in the past that caesarian sections performed in private medical institutions were far more than required. The activists fear instances where the insured amount would be exhausted quickly and the poor patients to fend for themselves.