Chandigarh Tribune: Chandigarh: Sunday,
May 22, 2016.
The idea of
introducing the cashless health insurance scheme seems to have worked out more
for the insurance companies than the poor.
As per
information obtained under the RTI Act, the government paid a premium of Rs10.8
crore to two insurance companies under Bhagat Puran Singh Sehat Bima Yojana
during 2014-15. However, beneficiaries claimed just Rs4.31 crore in the same
period.
Under the
scheme, the beneficiaries (blue card holders, construction workers etc.) are
eligible for cashless treatment up to Rs50,000 at 211 private and 192
government hospitals plus an insurance cover of Rs5 lakh in case of accidental
death or disability of the head of the family.
There were a
total of 15.36 lakh blue card holder families in the state and the government
registered 4.82 lakh families under this scheme. The government has now
extended it to farmers and traders as well.
National
Insurance Company (NIC) and United India Insurance Company (UIIC) were given
the contract of 11 districts each. The government paid Rs220 for each family to
the NIC and Rs227 to the UIIC for a year. A total of Rs10.8 crore was paid, but
the companies received claims worth Rs4.37 crore.
The NIC was
paid Rs4.94 crore and in return it settled claims worth Rs1.6 crore. Similarly,
the UIIC got Rs5.86 crore and settled Rs2.71 crore worth of claims. Thus the
insurance companies earned huge profits in the very first year (2014-15).
Under the
Rashtrya Sehat Bima Yojana (RSBY), Reliance General Insurance Company was paid
Rs4.13 crore premium, while it settled Rs3.35-crore claims. The scheme was
implemented in the state in 2013. The government pays Rs238 per family as
insurance premium to the company for the first year and Rs178 in the subsequent
years. The government under this scheme pays 25 per cent share, and the
remaining is contributed by the Centre. There are a total of 4.5 lakh BPL
families in the state but only 2.32 lakh have been enrolled under the RSBY.
Health
experts agree that the insurance model hardly works in favour of the
beneficiaries. “The idea behind the insurance model was to protect people from
catastrophic and out-of-pocket expenditure on health. But the systematic review
of the National Sample Survey Organisation (NSSO) data revealed that the
insurance model has failed to deliver on both aspects. As compare to that we
have noticed that when the governments strengthen their own healthcare
infrastructure and offered free facilities it was far more effective than the
insurance schemes. The Janani Shishu Suraksha Karyakaram is such example that
delivered when it came to child and maternal care,” said Dr Shankar Prinja,
health economics expert, School of Public Health, PGIMER.
Ropar-based
RTI activist Dinesh Chadha, who got this information under the RTI Act, said
the government only paid premium to the companies and did nothing to spread
awareness among the people regarding the schemes. “Instead of dolling out
public money on insurance companies, the government should provide free
treatment in state hospitals,” he said.