India may be home to a robust health insurance market, but its consumers may be falling victim to exploitation, according to a new study sponsored by the World Health Organization. The study focuses on the Rashtriya Swasthya Bima Yojana (RSBY) program, which is a health insurance initiative sponsored by the Indian government. The RSBY program is designed to provide poor citizens with access to health insurance policies that are affordable, yet comprehensive. Consumers may actually be paying much more for this insurance coverage than they should be, the study suggests.
Consumers face high out-of-pocket expenditures
According to the study, more than 50% of the consumers that enroll in the RSBY program pay for medical care themselves, rather than insurance companies footing the bill, at time of admission. This out-of-pocket expenditure accounts for significant financial pressure on many of the less-privileged consumers that rely on the RSBY program to find the health insurance coverage that they need. Researchers and the World Health Organization suggest that this is a violation of the agreements made between hospitals, insurance companies, and the Indian government.
RSBY program may be violating agreements
The study shows that approximately 36% of consumers enrolled in the RSBY program were directed to purchase medications from groups outside of the program by their health care providers. Insurers have also been refusing to cover claims, even though these claims are covered by the policies held by those covered through the RSBY program. The study suggests that the problems with the program are contributing to a major financial crisis that continues to develop in India and is preventing some people from receiving the health insurance coverage that they need.
Lack of governance cited as major problem
The study claims that one of the primary problems of the RSBY program is the fact that it is only loosely governed by the government and insurance companies. The study calls for Indian agencies to take notice of the problem and address the issue of governance immediately in order to ensure that consumers are being treated fairly and not being taken advantage of.
