Landscape study of Health Payer Systems

In India, more than two-thirds of health expenses continue to be paid out of pocket.To achieve universal health coverage (UHC), the Government of India launched an ambitious public health insurance program called the Pradhan Mantri Jan Arogya Yojana or PMJAY in 2018, that is expected to cover 100 million families or nearly 500 million people. The Employee State Insurance (ESI), the oldest social insurance program in the country covers nearly 130 million people that constitute the formal labor workforce. Central and State governments and many public sector undertakings cover their employees through contributory health insurance programs. Army and Railways have their own employee health schemes. Private health insurance is witnessing a double digit growth over the last decade.

In the absence of cohesive planning, the payer system has been evolving in an unorganized fashion, leading to dysfunctional payer systems. Despite coverage by schemes like ESI and state-level public health insurance programs like Arogyashree, beneficiaries continue to spend significant amounts of money out of their pockets. There is a consistent performance assessment framework for these payer systems.

InOrder is carrying out a landscape study to understand the various aspects of payer systems, consisting of beneficiaries, providers, insurers, regulators etc., It intends to bring out a clear outline of the structure, processes and functions of the payer system and a scientific framework to assess their performance. The study will also understand the health seeking and health financing behavior of people.