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Dr.Niraj K Pawan, Ms.Priyanka Kapoor, Dharmendra Ahuja*

Directorate of Medical & Health Services, Govt. of Rajasthan, Jaipur, Rajasthan, india.

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ABSTRACT

The health inequities remain high in Indian subcontinent as health Expenses clearly favors the rich population & organized sector workers, the Out of reach (OOR) spending is as high as 79% which affects the poor in the very bad manner. The focus of the manuscript is to examine the potential which Group Health Insurance (GHI) offers to improve the health-care access of rural, low-income population & the people in unorganized sector. This is done by drawing empirical evidence from various nations on their experiences of implementing GHI Programs & its potential for applications to Indian subcontinent, problems & challenges faced & the policy & management lessons that may be applicable to Indian subcontinent. It can be concluded that GHI Programs have proved to be effective in reducing the Catastrophic Health Expense (CHE) of people. But success of such Programs depends on its design, benefit package it offers, its management, economic & non-economic benefits perceived by enrollees & solidarity among community members. Collaboration of government, NGO’s & donor agencies is very crucial in extending coverage; similarly overcoming the mistrust that people have from such Programs & subsidizing the insurance for the many who cannot pay the premiums are paramount factors for success of GHI in Indian subcontinent. One of the biggest challenges for the health system is to address the piecemeal approach of GHI Programs in extending health insurance & inability of such Programs to cover a large number of poor & the unorganized sector workers. Also, there is a need for a stronger policy research to demonstrate: 1) how such Programs can cover a larger risk pool, 2) how such Programs can enroll a large number of people in the unorganized sector, 3) the interaction of GHI Programs with other funding Programs & its link to the health system.

Keyword: Community Based Health Insurance, Catastrophic Health Expense, Healthcare Funding, Health Equity, Indian subcontinent

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