Falling Through the Gaps: Women Accessing Care under Health Insurance Schemes in Karnataka

Abstract

This article focuses on the struggles of women from marginalised communities in accessing health care through health insurance schemes like Rashtriya Swasthya Bima Yojana (RSBY) and Vajpayee Arogyasri Scheme (VAS). It also draws attention to the design and implementation of the health insurance schemes and how they exclude the most vulnerable—ailing, single and elderly women. The article foregrounds the politics and futility of ‘cards’ used under the schemes by juxtaposing women’s struggle to access them with policymakers’ misplaced priorities of diverting scarce resources from government facilities and ‘non-profitable’ disease prevention activities to ‘profitable’ tertiary care services in the private sector. It further illustrates the opaque administrative structure, each with its own trusts, state nodal agency (SNA), the third-party administrator (TPA), empanelled hospitals, insurance companies and vendors, making it impossible to hold anyone accountable for violations and lapses.