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Feature Universal healthcare

Protecting India’s poorest from unaffordable medical bills

BMJ 2012; 345 doi: (Published 08 November 2012) Cite this as: BMJ 2012;345:e7554
  1. Patralekha Chatterjee, journalist, New Delhi, India
  1. patralekha.chatterjee{at}

Government schemes are bringing healthcare insurance to some of India’s poorest people, reports Patralekha Chatterjee. But are these schemes alone the solution to the debt and destitution that medical bills can bring?

“It is unacceptable that almost 80% of the expenditure on healthcare by our people is met by personal, out of pocket, payment,” India’s new president, Pranab Mukherjee, said on 16 October.1 “I am shocked to note that as many as 40 million people in this country plunge into poverty each year due to expenses for medical treatment.” A report for the journal Economic and Political Weekly estimated that 35 million people were pushed into poverty by the need to pay for healthcare in 1993-4 and 47 million people in 2004-5.2

The topic of medical bills has been inching up the political agenda, and in the past year several states have introduced health insurance schemes for poor people, often bearing the name of a chief minister or popular political leader. For example, Karnataka recently launched the Vajpayee Arogyashree programme, named after the veteran leader of the governing party and former prime minister.

But health economists are divided on whether new government sponsored health insurance schemes will save India’s poor from debt and destitution. This debate comes at a time when the federal government has taken the first steps towards universal healthcare.3 And India’s insurance sector is opening up: two years ago private companies had 6.8 million policies covering nearly 55 million people—a huge jump from fewer than nine million people covered five years earlier.4

India has made progress in healthcare coverage. A recent study for the federal Ministry of Health and Family Welfare carried out by the World Bank reported that more than 300 million people, or more than 25% of India’s population, had …

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