Health Insurance and Healthcare Financing
Social Justice & Development
- PYQs8
- Articles1
Background
UPSC frequently examines issues related to social security, public health, and the financial burden of healthcare on citizens. Understanding health insurance mechanisms, their limitations, and policy solutions is crucial for assessing social justice and development initiatives.
Health insurance is a critical financial instrument designed to cover medical expenses, providing protection against the escalating costs of healthcare. In India, the landscape of healthcare financing involves a mix of public schemes, private insurance, and significant out-of-pocket expenditure, posing challenges for affordability and access.
Facts & tables
- Inadequacy of Sum Insured (SI)
- Rising healthcare costs, especially in urban areas, render standard insurance coverage insufficient, leading to significant out-of-pocket expenses.
- Impact of Sub-limits
- Policy clauses like sub-limits on room rent or surgeon's fees further increase the financial burden on individuals, despite having insurance.
- Role of Top-up and Self-insurance
- Strategies like purchasing top-up policies or maintaining a medical fund (self-insurance) are explored as ways to augment basic coverage and manage costs.
- Age-related Challenges
- Premiums rise sharply with age, and obtaining or enhancing policies becomes difficult, highlighting the need for early and continuous financial planning for healthcare.
| Type | Reference |
|---|---|
| Conceptual area | Social Security |
| Body | Role |
|---|---|
| Insurance Regulatory and Development Authority of India (IRDAI) | Regulates |
Prelims angle
Prelims angle: Statement-based questions
Prelims angle: Multi-statement analysis
- Rising healthcare costs diminish Sum Insured (SI) adequacy.
- Sub-limits on services increase out-of-pocket expenses.
- Top-up policies and self-insurance are supplementary strategies.
- Age significantly impacts insurance premiums and accessibility.
- Proactive financial planning for healthcare is essential.
| Year | Framing tags |
|---|---|
| 2026 | Multi-statement analysis, Factual recall |
| 2024 | Multi-statement analysis, Factual recall |
| 2024 | Multi-statement analysis, Institutional roles and functions |
| 2023 | Statement-based questions, Multi-statement analysis |
| 2023 | Multi-statement analysis, Policy measures |
| 2022 | Multi-statement analysis, Factual recall |
| 2017 | Multi-statement analysis, Policy measures |
| 2016 | Multi-statement analysis, Factual recall |
Timeline
-
Social Security
Conceptual area
-
Prelims 2016
Multi-statement analysis, Factual recall
-
Prelims 2017
Multi-statement analysis, Policy measures
-
Prelims 2022
Multi-statement analysis, Factual recall
-
Prelims 2023
Statement-based questions, Multi-statement analysis
-
Prelims 2023
Multi-statement analysis, Policy measures
-
Prelims 2024
Multi-statement analysis, Factual recall
-
Prelims 2024
Multi-statement analysis, Institutional roles and functions
-
Prelims 2026
Multi-statement analysis, Factual recall
-
Med cover inadequate and not affordable
Health insurance in India faces challenges of adequacy and affordability due to rising costs and policy limitations like sub-limits. Strategies like top-ups and self-insurance are employed, but age-related premium hikes and access issues necessitate comprehensive financial planning for healthcare.
See also
No related topics linked yet.
Past papers
2016–2026 · 8 questions
In the news
Med cover inadequate and not affordable
Health insurance in India faces challenges of adequacy and affordability due to rising costs and policy limitations like sub-limits. Strategies like top-ups and self-insurance are employed, but age-related premium hikes and access issues necessitate comprehensive financial planning for healthcare.
Try these PYQs
Consider the following statements :
Statement-I :India's public sector health care system largely focuses on curative care with limited preventive, promotive and rehabilitative care.
Statement-II: Under India's decentralized approach to health care delivery, the States are primarily responsible for organizing health services.
Which one of the following is correct in respect of the above statements?
* Statement I is correct: India's public healthcare system prioritises curative care, which focuses on treating existing illnesses. Preventive, promotive, and rehabilitative care, which aims to prevent diseases, promote good health, and help people recover from illness, receive less emphasis. * Statement II is correct: India's healthcare system follows a decentralised approach. The central government sets policies and provides financial assistance, but individual states are responsible for organising and delivering health services to their populations. This allows for flexibility based on local needs and contexts.
Therefore, the answer is Both Statement I and Statement II are correct.
Consider the following statements in relation to Janani Suraksha Yojana:
1. It is safe motherhood intervention of the State Health Departments.
2. Its objective is to reduce maternal and neonatal mortality among poor pregnant women.
3. It aims to promote institutional delivery among poor pregnant women.
4. Its objective includes providing public health facilities to sick infants up to one year of age.
How many of the statements given above are correct?
Statement 1 is incorrect: Janani Suraksha Yojana (JSY) is a 100% Centrally Sponsored Scheme under the National Health Mission (NHM). It is a central intervention implemented by states, not an intervention of the State Health Departments. Statement 2 is correct: The primary objective is to reduce maternal and neonatal mortality by encouraging safe, institutional births. Statement 3 is correct: The scheme provides a cash incentive to mothers to promote institutional delivery, particularly among those from BPL, SC, and ST households. Statement 4 is incorrect: While care for sick infants is a priority under the National Health Mission, the provision of free facilities for sick infants up to one year of age is specifically a feature of the Janani Shishu Suraksha Karyakram (JSSK) launched in 2011. JSY, launched in 2005, is primarily a conditional cash transfer scheme for delivery.
With reference to Ayushman Bharat Digital Mission, consider the following statements:
1. Private and public hospitals must adopt it.
2. As it aims to achieve universal health coverage, every citizen of India should be part of it ultimately.
3. It has seamless portability across the country.
Which of the statements given above is/are correct?
Ayushman Bharat Digital Mission aims to provide digital health IDs for all Indian citizens to help hospitals, insurance firms, and citizens access health records electronically when required. Statement 1 is incorrect. Ayushman Bharat Digital Mission (ABDM) has not made it mandatory for adoption by private and public hospitals. Its adoption so far would be voluntary. Participation in ABDM is voluntary including for citizens. Participation of a healthcare facility or an institution is also voluntary and shall be taken by the respective management (government or private management). Statement 2 is incorrect. The aim of the Ayushman Bharat Digital Mission is to facilitate the ease of access to medical records and it is not been mandated to have every citizen as its part though the facility is available to every citizen on a consent basis. Statement 3 is correct. ABDM will have a national footprint and will enable seamless portability across the country through a Health ID Personal Health Identifier.
Which of the following are the objectives of ‘National Nutrition Mission’?
1. To create awareness relating to malnutrition among pregnant women and lactating mothers.
2. To reduce the incidence of anaemia among young children, adolescent girls and women.
3. To promote the consumption of millets, coarse cereals and unpolished rice.
4. To promote the consumption of poultry eggs.
Select the correct answer using the code given below:
The National Nutrition Mission, also known as Poshan Abhiyaan, has several objectives. - The first objective is to create awareness relating to malnutrition among pregnant women and lactating mothers. - The second objective is to reduce the incidence of anaemia among young children, adolescent girls and women. These two objectives are clearly stated in the mission's goals. Hence, statements 1 & 2 are correct. However, the promotion of the consumption of millets, coarse cereals and unpolished rice, and the promotion of the consumption of poultry eggs are not explicitly stated as objectives of the mission. Hence, statement 3 & 4 are incorrect.
With reference to ‘Pradhan Mantri Fasal Bima Yojana’, consider the following statements:
1. Under this scheme, farmers will have to pay a uniform premium of two per cent for any crop they cultivate in any season of the year.
2. This scheme covers post-harvest losses arising out of cyclones and unseasonal rains.
Which of the statements given about is/are correct?
The Pradhan Mantri Fasal Bima Yojana (PMFBY) is a government-sponsored crop insurance scheme. Statement 1 is Incorrect: Under this scheme, farmers have to pay a uniform premium of 2% for all Kharif crops, 1.5% for all Rabi crops, and 5% for commercial/horticultural crops. The premium rate is not uniform for all crops in all seasons. Statement 2 is Correct: The scheme does cover post-harvest losses arising out of cyclones and unseasonal rains. Hence, option B is the correct answer.
Show 3 more PYQs
Which of the following statements with respect to the Revamped Rashtriya Gram Swaraj Abhiyan (RGSA) is/are correct ?
1. The period of its implementation is 1st April, 2021 to 31st March, 2026.
2. The key objective of the Revamped RGSA is to develop the governance capabilities of the Panchayati Raj Institutions to deliver on the Sustainable Development Goals.
3. The share of the Central funding for the Revamped RGSA is 100% for all States and Union Territories.
Select the answer using the code given below :
Statement 1 is Incorrect: The Revamped Rashtriya Gram Swaraj Abhiyan (RGSA) was approved by the Cabinet Committee on Economic Affairs for implementation from 1st April 2022 to 31st March 2026 (co-terminus with the 15th Finance Commission period), not from 1st April 2021. Statement 2 is Correct: The primary objective of the revamped scheme is to develop and enhance the governance capabilities of Panchayati Raj Institutions (PRIs) so they can effectively deliver on the Sustainable Development Goals (SDGs). It focuses on the localization of SDGs at the grassroots level through inclusive local governance. Statement 3 is Incorrect: The Revamped RGSA is a Centrally Sponsored Scheme, meaning the funding is shared between the Centre and the States. It is not 100% centrally funded for all States and UTs. The sharing pattern is 60:40 (Centre:State) for general category States, and 90:10 for North-Eastern States, Hilly States, and the Union Territory of Jammu & Kashmir. 100% Central funding applies only to other Union Territories and specific Central components of the scheme. Therefore, option B is the correct answer.
With reference to Corporate Social Responsibility (CSR) rules in India, consider the following statements:
1. CSR rules specify that expenditures that benefit the company directly or its employees will not be considered as CSR activities.
2. CSR rules do not specify minimum spending on CSR activities.
Which of the statements given above is/are correct?
* Statement 1: Correct. The Corporate Social Responsibility (CSR) rules in India state that expenditures aimed at benefiting the company's business interests or its employees (such as those related to employee welfare or activities that are a direct business benefit) will not be counted as CSR activities. The focus of CSR is on activities that benefit society at large and not just the company or its direct stakeholders. * Statement 2: Incorrect. Under the Companies Act, 2013, CSR rules do specify a minimum spending requirement. Companies meeting certain criteria (like having a net worth of ₹500 crore or more, or an annual turnover of ₹1,000 crore or more, or a net profit of ₹5 crore or more) must allocate at least 2% of their average net profits over the last three years towards CSR activities. So, the correct answer is: A. 1 only
Consider the following statements regarding World Toilet Organization :
1. It is one of the agencies of the United Nations.
2. World Toilet Summit, World Toilet Day and World Toilet College are the initiatives of this organization, to inspire action to tackle the global sanitation crisis.
3. The main focus of its function is to grant funds to the least developed countries and developing countries to achieve the end of open defecation.
Which of the statements given above is/are correct?
* Statement 1 is incorrect. The World Toilet Organization (WTO) is not an agency of the United Nations. It is an international non-profit organization. * Statement 2 is correct. The WTO is known for its initiatives like World Toilet Summit, World Toilet Day, and World Toilet College, all aimed at addressing the global sanitation crisis. * Statement 3 is incorrect. While the WTO advocates for improved sanitation and hygiene, its primary function is not to grant funds. It focuses on advocacy, education, and capacity building to achieve its goals. _Therefore, only statement 2 is correct._