An Analytical Study of Health Insurance Schemes Offered by the Central and State Governments of India: A Comprehensive Review

Abstract

Health insurance schemes play an important role in improving access to healthcare and protecting economically vulnerable households from the financial burden of medical treatment.  Government health insurance schemes play a crucial role in promoting universal healthcare access, especially for those who might not have access to private insurance options In a nation as diverse and dynamic as India, ensuring accessible and affordable healthcare remains a monumental challenge In India, the federal and state governments' provision of public health insurance is a vital step in the direction of universal health coverage and the removal of financial obstacles to accessing healthcare. The primary state-specific models and significant government-sponsored health insurance programs like PMJAY, CGHS, and ESIS are thoroughly analyzed using secondary data in this study. The study assesses coverage trends, financial protection outcomes, service utilization, and significant operational issues using information from government reports, national surveys, scholarly studies, and publications from international agencies. The results show notable improvements in enrolment and service accessibility, but they also point to continuing problems like inadequate financial risk protection, unequal access in rural areas, and restricted outpatient coverage. In order to ensure more efficient and equitable healthcare delivery, the study ends by suggesting policy changes that improve scheme design, beneficiary awareness, and system accountability.