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 Table of Contents  
Year : 2022  |  Volume : 38  |  Issue : 3  |  Page : 297-300

Poor enrollment of persons with disabilities in niramaya health insurance scheme over a decade under the indian national trust

1 Department of Psychiatry, NIMHANS, Bengaluru, Karnataka, India
2 Department of Pediatrics, Kakatiya Medical College, Warangal, Telangana, India
3 Department of Psychiatric Social Work, NIMHANS, Bengaluru, Karnataka, India

Date of Submission06-Jul-2020
Date of Decision30-Nov-2020
Date of Acceptance28-Dec-2020
Date of Web Publication17-Feb-2022

Correspondence Address:
Dr. Hareesh Angothu
Department of Psychiatry, NIMHANS, Bengaluru - 560 029, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijsp.IJSP_189_20

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Background: Niramaya Health Insurance Scheme is offered for persons with disabilities (PwD) under the National Trust Act, 1999, since 2008. There is less awareness among health professionals, PwD, and caregivers about this. Aims: The aim of the study was to study the number of enrolled PwD in the Niramaya Health Insurance Scheme across the country since its inception. Methods: Annual reports of the National Trust were available in the public domain, and information obtained from the National Trust was used for analysis. Results: Total enrollments have steadily increased from 36,153 (2008–2009) to 96,716 (2018–2019). Madhya Pradesh state accounted for more than two-thirds of total enrollments in the year 2018–2019, and enrollments from many other states and union territories are lesser than 100. Conclusions: After a decade of its launch, less than a fraction of eligible PwD is enrolled in the scheme. Multipronged efforts are needed to promote the enrollment and utilization of the benefits of the Scheme.

Keywords: Autism, cerebral palsy, health insurance, intellectual disability, multiple disability, National Trust, Niramaya

How to cite this article:
Angothu H, Ajmera S, Thanapal S, Reddy KS, Jagannathan A, Muliyala KP, Thirthalli J. Poor enrollment of persons with disabilities in niramaya health insurance scheme over a decade under the indian national trust. Indian J Soc Psychiatry 2022;38:297-300

How to cite this URL:
Angothu H, Ajmera S, Thanapal S, Reddy KS, Jagannathan A, Muliyala KP, Thirthalli J. Poor enrollment of persons with disabilities in niramaya health insurance scheme over a decade under the indian national trust. Indian J Soc Psychiatry [serial online] 2022 [cited 2022 Oct 3];38:297-300. Available from: https://www.indjsp.org/text.asp?2022/38/3/297/337869

  Introduction Top

According to the Indian National Sample Survey Organization, outpatient treatment from private sector accounts for more than 70% of out of pocket expenditure on health care.[1] As health-care expenditure pushes several people into poverty, various strategies including tax-based arrangements, social insurance, and voluntary health insurance have been advised.[2] In Low- and middle-income countries like India, there is a reliable and positive association between disability and poverty.[3] As available health insurance policies do not cover preexisting conditions (such as disabilities) and charge a high premium, it is out of reach of persons with disabilities (PwDs). Subsidized health insurance is a potential strategy to enhance health-care utilization among PwD. The Government of India enacted The National Trust Act (NTA), 1999, for the welfare of persons with mental retardation (an older term for intellectual disability), autism, cerebral palsy, and multiple disabilities. Under the NTA 1999, a PwD is defined as a person with mental retardation (herein after referred to as Intellectual Disability), or autism, or cerebral palsy, or multiple disabilities.[4] Persons with intellectual disability (PID) are likely to have higher hospitalization rates, higher prevalence of chronic medical conditions such as diabetes, obesity, arthritis, and cancer and higher mortality rates than the general population.[5],[6] To promote access and utilization of health-care services by PwD, the National Trust launched the Niramaya Health Insurance Scheme in 2008. It offers annual coverage of Rs. 1 lakh [with sublimits; refer to [Table 1]] on a reimbursement basis for a nominal premium. A unique feature is its coverage for outpatient services including therapies (such as speech therapy or physiotherapy) and medicines (such as methylphenidate and levetiracetam) which may not be available in government hospitals near the residence of PwD.
Table 1: Niramaya insurance scheme for persons with disabilities details

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There is less awareness about the Niramaya Insurance Scheme among health professionals, PwD, and caregivers. There is a lack of data on the number of persons with ID, autism, and cerebral palsy in India. National Mental Health Survey (NMHS) 2016 estimated that about six in every 1000 general population had ID.[7] For a total population of 120 crores, PID will be, therefore, about 72 lakhs. The present study examined the enrollment of PwD in Niramaya Insurance since its launch in March 2008.

  Methods Top

Annual reports are published by the National Trust from the year 2008 and are available online at their official website.[4] Details of PwD enrolled in Niramaya Scheme were gathered from the National Trust annual reports. As state-wise Niramaya Scheme enrollment data are not available in the annual reports, the National Trust was contacted by one of the authors. State-wise enrollment data shared by the Nation Trust for the year 2017–2018 are described in [Table 2] under results.
Table 2: State and union territory wise enrollment for the year 2017-2018

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  Results Top

Details of PwD enrolled annually, the number of claims, and amount spent for implementing the Scheme are described in [Table 3]. There is a steady increase in the number of PwD enrolled under this Scheme from 36,153 (2008–2009) to 96,716 (2018–2019). Except 2011–2012, the breakup of fresh enrollments and renewals are not available. The number of claims was <1% of total enrollments during the inception year. 2018–2019 claim data suggest that 9691 PwDs received reimbursement of an average Rs. 9000/-each under this Scheme.[8]
Table 3: Niramaya insurance scheme beneficiary enrollment and claim details since inception

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Table 2 depicts the state-wise and UT breakup of enrollments for the year 2017–2018. Madhya Pradesh alone accounted for more than two-thirds of the total Niramaya Insurance enrollments in the year 2017–2018. Kerala, Andhra Pradesh, Gujarat, Karnataka, and Tamil Nadu were the only other states that had more than 1000 enrollments each. A total of 13 states and UTs had ”nil” or single digit enrolments.

  Discussion Top

The number of potential beneficiaries for Niramaya Insurance (including persons with autism, cerebral palsy, and multiple disabilities) is likely to be higher than the 72 lakh persons with ID based on the NMHS 2016 data. Even after a decade of its launch, only a small proportion of PwDs are benefiting from Niramaya with skewed distribution across states.

Some bottlenecks in enrollments include registration and renewal only through registered nongovernmental organizations (NGOs), need for the PwD to have a bank account, and duration of the policy only for a financial year irrespective of the day of joining. The paperwork to apply and claim reimbursements is cumbersome, especially to families from rural areas and lower socioeconomic status. In our experience, beneficiaries receive policy documents without detailed instructions or guidance on the reimbursement process. Besides, original bills need to be submitted to the insurance company before 30 days.

Indian National Productivity Commission reported a range of challenges to access Niramaya by PwD such as poor understanding by registered NGOs, unusual delay in getting the policy cards by PwD, and inadequate response from the insurance company appointed under this.[9] Family caregivers dropped out from this after expressing difficulty in upfront spending and then waiting for reimbursement. NPC recommendation to increase the claim submission timeline from 30 days to 90 days was not considered by the National Trust. Niramaya Health Insurance coverage has not been raised according to inflation and has remained stagnant at Rs. 1 lakhs since its launch. There is a need for the popularization of this scheme at a grassroots level by sensitizing the health workers assigned to screen for developmental delays under early intervention programs. Multipronged efforts are needed to spread awareness about the scheme, cut down on bureaucracy to make the enrollment user friendly, and set up effective grievance redressal mechanisms to promote utilization of health-care services for the welfare of PwD. Such an overall low enrollment rate and nil enrollments in certain states need further investigation, preferably by a third party to understand the reasons behind this finding. A periodic assessment of increasing health-care costs should be considered, and benefit rates should be revised considering inflation.

  Conclusions Top

The Niramaya Health Insurance Scheme under the aegis of the NTA, 1999, has been underutilized by eligible PwD across many states, even after 12 years of its launch. The challenges in its implementation necessitate the involvement of all the stakeholders to improve the enrollment of eligible beneficiaries.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Kumar A, Furtado KM, Jain N, Nandra S. A comment on the article “Falling Sick, Paying the Price: NSS 71st Round on Morbidity and Costs of Healthcare” (EPW, 15 August 2015). Econ Polit Wkly 2015;50:46-7.  Back to cited text no. 1
Sivakumar T, James JW, Chethan B. Health insurance schemes for children and adolescents with psychiatric disability (Editorial). J Indian Assoc Child Adolesc Ment Health 2017;13:1-9.  Back to cited text no. 2
Banks LM, Kuper H, Polack S (2018) Correction: Poverty and disability in low- and middle-income countries: A systematic review. PLOS ONE 13(9): e0204881.  Back to cited text no. 3
The National Trust for the Welfare of Persons with Autism, Cerebral Palsy, Mental Retardation and Multiple Disabilities. New Delhi; 2019. Available from: https://www.thenationaltrust.gov.in/content/. [Last accessed on 2020 Apr 30].  Back to cited text no. 4
Emerson E, Hatton C, Baines S, Robertson J. The physical health of British adults with intellectual disability: Cross sectional study. Int J Equity Health 2016;15:11.  Back to cited text no. 5
Hosking FJ, Carey IM, Shah SM, Harris T, DeWilde S, Beighton C, et al. Mortality among adults with intellectual disability in England: Comparisons with the general population. Am J Public Health 2016;106:1483-90.  Back to cited text no. 6
Gururaj G, Varghese M, Benegal V, Rao GN, Pathak K, Singh LK, et al. National Mental Health Survey of India, 2015-16: Prevalence, Patterns and Outcomes. Bengaluru: National Institute of Mental Health and Neuro Sciences, NIMHANS Publication No. 129; 2016.  Back to cited text no. 7
National Trust Annual Report 2018-19. Available from: https://www.thenationaltrust.gov.in/upload/uploadfiles/files/English_new_PASTING_compressed.pdf. [Last accessed on 2020 Dec 07].  Back to cited text no. 8
Final Report of Impact Evaluation of Schemes of National Trust, National Productivity Council of India; 2014. p. 1-186. Available from: https://www.dropbox.com/s/fn0r9z0926eahhd/NATIONAL%20TRUST%20IMPAACT%20EVALUATION%20REPORT%20NPC.pdf?dl=0. [Last accessed on 2020 Dec 11].  Back to cited text no. 9


  [Table 1], [Table 2], [Table 3]


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