After assessing health insurance policies in various states and countries, top officials of the state medical and health department have recommended providing insurance to people under a hybrid system. Following discussions with insurance companies, they suggested to the Chief Minister that implementing health insurance in a hybrid system for all 5 crore people of the state would be beneficial. It was also indicated that 1.43 crore white ration card holders in the state are currently receiving treatment through NTR Vaidya Seva Trust. In addition, there are 8.13 lakh employees, pensioners, and people above the poverty line (APL). The goal of the TDP coalition government is to ensure that no one in the state is without health insurance. However, the implementation of Rs.25 lakh insurance for 1.60 crore families would be financially burdensome, requiring an expenditure of around Rs.10-12 thousand crores.
The proposed hybrid policy aims to offer Rs.25 lakh insurance to all citizens without overburdening the government. Presently, only 13 to 15 lakh people in the state seek medical treatment annually, with 95 percent of those treated through NTR Vaidya Seva Trust spending less than Rs 2.50 lakh. It is estimated that 3 percent of the remaining individuals spend less than Rs.5 lakh and 2 percent spend less than Rs.15 lakh. Based on this, health officials have formulated several proposals.
Under the proposed hybrid system, the government will pay the premium to insurance companies up to the cost of Rs.2.50 lakh for 1.60 crore families. If the cost exceeds Rs.2.50 lakh, treatment will be provided by NTR Vaidya Seva Trust up to Rs.25 lakh. Consequently, every family will receive an insurance card along with an NTR Vaidya Seva Trust Card, ensuring a health insurance coverage of Rs 25 lakh for all citizens while reducing the financial burden on the government. The government estimates it will spend Rs.2,500 crores annually for health insurance, which is currently the amount being spent by the trust for network hospitals.
A special focus has been placed on government employees and pensioners. It has been noted that due to non-implementation of EHS employees, many are facing significant difficulties. To address this, 5.14 lakh employees and 2.99 lakh pensioners in the state are now covered under health insurance and provided with insurance cards. Additionally, efforts are being made to improve facilities for employees, such as providing special rooms during treatment, using high-quality medicines, and increasing the number of surgeries.
In regards to the APL population in the state, it has been proposed that the government will also pay their premiums and provide insurance up to Rs.25 lakhs, with the insurance company covering up to Rs.2.50 lakh. Nevertheless, the matter of who will provide insurance for the remaining Rs.22.50 lakh is still under consideration. The government is exploring options such as increasing the premium paid by the government to APL families and making direct payments to insurance companies.
The state health department officials have examined the health insurance model in Switzerland, where every citizen is required to have insurance. They are in contact with experts in Switzerland, as the Swiss model of health insurance is considered highly effective. A report on the implementation process based on the Swiss approach will be presented to the Chief Minister soon. Upon finalizing regulations and receiving government approval, the officials will proceed with the tender process, aiming to provide health insurance to all citizens once it is completed.