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Experiences with Government Sponsored Health Insurance Schemes in Indian States: A Fiscal Perspective

Publication date

Nov, 2019


NIPFP Working Paper No. 283


Mita Choudhury, Shruti Tripathi and Jay Dev Dubey


The implications of expanding GSHI schemes in India has not been analyzed from a fiscal perspective. This paper analyzes the experiences of some of the early and largest GSHI schemes implemented in Indian States – in Andhra Pradesh, Tamil Nadu and Karnataka to understand the fiscal implications of initiating such schemes. We analyze three aspects: (a) the extent of fiscal burden on account of GSHI schemes and its consequences on other health expenditures, (b) the factors contributing to the extent of fiscal burden and (c) the effectiveness of spending on the schemes in terms of reducing out of pocket expenditure, extent of hospitalization coverage, and improved access to hospitalization services. Results suggest that expansion of GSHI schemes may skew expenditure away from primary and secondary care towards tertiary care, if fiscal space is limited. Although the schemes are largely dependent on private health providers for delivering services, a competitive public health system may help in containing costs and the corresponding fiscal burden. The evidence on effectiveness of public spending through such schemes has been mixed. 

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