Background and Objective Healthcare in India is not a primary right, but is only a constitutional obligation of the State which refers only to a State's duty regarding improvement of primary health amongst its other duties.1 Art 39 : Specifies certain principles of policy to be followed by the State (e) That the health and strength of workers, men and women, and the tender age of children are not abused and that citizens are not forced by economic necessity to enter avocations unsuited to their age or strength; (f) That children are given opportunities and facilities to develop in a healthy manner and in conditions of freedom and dignity and that childhood and youth are protected against exploitation and against moral and material abandonment. Art. 47: Specifies duty of the State to raise the level of nutrition and the standard of living and to improve public health. The State shall regard the raising of the level of nutrition and the standard of living of its people and the improvement of public health as among its primary duties and, in particular, the State shall endeavour to bring about prohibition of the consumption except for medicinal purpose of intoxicating drinks and of drugs which are injurious to health. As per WHO's World Health Statistics of 2007, India ranked 184 among 191 countries in terms of public expenditure on health as a percent of GDP. It is surprising to that despite of all advancements and progress made in the last one decade, public spending on health as a percent of GDP in India has stagnated in the past two decades, from 1990-91 to 2009-10, varying from 0.9 to 1.2 percent of GDP. While public spending on healthcare is low, the out of pocket (OOP) expenditure by individuals, contributes majorly to the expenditure on healthcare, 75% Out of Pocket (OOP) spending. 40% of hospitalised are pushed below poverty line or into lifelong debt due to lack of financial planning. In 2007, private spending in India constituted nearly 74 percent of the total spending on health drastically less in comparison to some other countries. Of all the risks facing poor households, health risks pose the greatest threat to their lives and livelihoods. A health shock adds health expenditures to the burden of the poor. Even a minor health shock can cause a major impact on poor persons' ability to work and curtail their earning capacity. Moreover, given the strong link between health and income at low income levels, a health shock usually affects the poor the most. Thus, in a system that gets dominated by outof- pocket expenditures, the poorer pay disproportionately more on health as compared to their earnings than the rich and this leads to a vicious cycle of ill health as access to healthcare is governed by an individual's ability to pay. The other challenge that India faces today, is Demographic Transition with Low Birth Rate & Low Death Rate. The fact here is that the life expectancy of the people is increasing and, as a result, the number of ageing or elderly population too is proportionately increasing. Demographic Transition has further led to an Epidemiological transition characterized, as a shift away from diseases of famine to receding pandemics to an age of generative and manmade diseases. 3 fundamental changes have taken place with the above transition, namely: 1. Mortality decline due to infectious diseases, injuries. and mental illness. 2. Shift of the burden of death and diseases from the younger to the older groups. 3. Change in health profile from one dominated by death to one dominated by morbidity. In such a scenario, Curative Treatment becomes the mantra to ensure better Health Indices. However, with the polarization being on Curative treatment, the Healthcare Costs have escalated with a Medical Inflation Index hovering around 10-12% YoY (year on year), in addition to this, with Medical Advances, the cost of treatment further escalates. Most of the Public Healthcare in India, in the form of centrally funded schemes, focuses on Preventive & Promotive Care not taking into account, Curative Care. Due to defocused effort on the Curative Cure, healthcare in India has currently become one of the most unregulated sectors with expenses increasing disproportionately. Moreover, even in Public Healthcare units, the curative care is not "all free", with one fourth of the expenses being out of pocket. These factors affect the informal sector of the country who are not protected by any of the financing or government supported schemes like ESIC, CGHS, etc. To counter the above, two broad methods have been proposed as alternatives on optimal resource utilization: Cost Containment l Privatization Community Participation l Cost Sharing l User Financing l Health Insurance Health Insurance has been useful as a tool for augmenting financial resources available for care, and as a means of better linking health demand to the provision of service. Many states have now implemented Health Insurance Schemes to cover the aspects of Curative Care. Most of the State/Central Projects which are currently running, work on the concept of Horizontal Cross Subsidization as opposed to Mediclaim which tends to be run as Vertical Cross Subsidization. The Cross Subsidization is also due to the Risk Solidarity in the schemes (a blend of both high and low risk individuals). Horizontal: Within the economic group Vertical: Across various groups (economic, age, gender, etc.) These schemes are also common on the principle of determining the Premiums. These are based on the Community rating with or without a premise of Experience rating. On the other hand, there are few states where Self Funded Schemes work very well, under the Governance of the State Govt. some examples being the Mukhyamantri Amrutum Yojana in Gujarat, Yeshasvini Cooperative Farmers Healthcare scheme in Karnataka (these schemes may be partly funded by the Government and partly by the beneficiaries). Design and Methods This paper is a comparative analysis of select mass health insurance schemes, both successful & unsuccessful, which have been implemented in India in the past few years. The Scope of the paper will be Comparative Analysis of the following schemes: 1. Rashtriya Swasthya Bima Yojana, Pan India 2. Rajiv Arogyri Scheme, Andhra Pradesh 3. Chief Minister's Comprehensive Health Insurance Scheme, Tamil Nadu 4. Bhai Ghanhya Sehat Sewa Scheme, Punjab 5. National Trust 6. Weavers' & Artisans' & Sericulture 7. Swarnajayanti Aarogya Bima Yojana, Goa 8. Mukhyamantri Amrutum Yojana, Gujarat The Stakeholders for these Schemes share a common relationship: 1. Source of funds: Government and beneficiaries in some instances 2. Beneficiaries- Population below poverty line or a community of similar socio-economic status 3. Fund pooling is often done by an Insurance company 4. Risk Management- Trust/society established by government 5. Service providers: Network Hospitals 6. Implementing Agency: Third Party Administrators These schemes differentiated from each other broadly on the basis of the following parameters: 1. Source of funding: State funded/ Insurance/Centre funded 2. Scope of coverage : Primary or Secondary & Tertiary coverage 3. Grading criteria for hospitals 4. Integration of Hospital Scores & rates for procedures 5. Provider Tendering for Procedures 6. Administration & Implementation of the schemes The various differentiators will be studied and documented as per observations for the purpose of learning what was best implemented, thought of and successful idea for bringing in the latest and quality care to the members of society who need it the most. Results There did not seem to be one scheme which allowed replication Pan India for better Health Indices, some being complementary to the others. This is so because: 1. Selection of packages and disease coverage is a factor that gets determined by the epidemiological trends and characteristics of the target community 2. Provider trends are dependent on local practices and culture. 3. Implementing States have different strategies, cultural practices and political environment. [ABSTRACT FROM AUTHOR]