Social Insurance for Oral Healthcare: Analysis of Two Insurance Schemes in India

Abstract

Objective: To assess the equity, access, and utilization of social health insurance schemes in India for oral healthcare services. Methodology: A case study approach was used with both qualitative and quantitative information, which was collected from various sources like personal interviews of informed persons in the scheme, annual reports of the scheme, and through the Right to Information Act 2003. Results: Employees' State Insurance (ESI) Scheme and Central Government Health Scheme (CGHS) are the large and oldest social insurance schemes implemented in India, covering approximately 12% of the population who are working in organized sectors. In terms of dental health, both the schemes provide a range of services through their centers without any capping or sealing for dental services. It also outsources the services through empaneled healthcare organizations with reimbursement mechanisms for 58 approved procedures with fixed rates. In terms of oral health, there is poor access and utilization of these schemes. Conclusion: The ESI scheme and CGHS can be a tool to achieve universal health coverage; however, it needs modification to be utilized to its optimum benefits.