Manorama Bakshi
Arjun Kumar
Goa’s Health Assurance Question
India’s health protection landscape has gradually moved from fragmented, state-specific insurance arrangements towards broader public assurance systems. Within this shift, Goa offers a distinctive model. The Deen Dayal Swasthya Seva Yojana (DDSSY) is not confined to low-income households but is based primarily on residency, extending cashless hospital care to a much wider section of the state’s population.
That broad reach, however, does not always translate into reliable access to care. Families can encounter renewal and digital verification problems at the point of treatment; private hospitals have raised concerns over reimbursements and package rates; and the five-year residency requirement leaves recent migrant workers outside DDSSY. These are not merely administrative gaps. When insurance cannot be accessed when it is needed, households can still be left with medical bills, depleted savings and, in serious cases, debt.
As Goa pursues Swayampurna Goa and the wider ambition of Viksit Bharat @2047, the question is therefore not simply how many people are enrolled, but how dependable that protection is in practice. This article examines what DDSSY has achieved, where its protections remain incomplete and what it would take to strengthen Goa’s health assurance model.
From Targeted Assistance to a Residency-Based Model
Goa’s health assurance system changed significantly with the introduction of DDSSY in September 2016. Its predecessor, the Goa Mediclaim Scheme, was largely restricted to households earning below ₹1.5 lakh annually and to procedures unavailable in government hospitals. Patients generally had to pay first and seek reimbursement later. DDSSY replaced this narrower approach with cashless treatment across government and empanelled private hospitals, making residency rather than income the principal basis of eligibility.
Residents who have lived in Goa for at least five years can enrol through a family health card. The annual registration or renewal fee is ₹200 for families of up to three members and ₹300 for larger families, with a 50% concession for specified groups. Following the July 2026 revision, the annual inpatient protection limit rose to ₹4 lakh for families of up to 3 members and ₹6 lakh for larger families.
DDSSY now covers more than 447 medical and surgical packages, alongside an outpatient medicine allowance of up to ₹15,000 annually for specified chronic conditions, including diabetes and hypertension. Mental health and Ayurveda hospitalisation in public institutions and certain high-end diagnostics are also included, with no age restriction on benefits. The scheme operates through 11 government and 67 private empanelled hospitals within and outside Goa and alongside Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), which provides interstate portability to eligible beneficiaries.
How DDSSY Works in Practice
Nearly a decade after its launch, DDSSY covers around 1.81 lakh families, or 6.6 lakh people. The scale is significant for a scheme that replaced a much narrower form of financial protection, but it also comes with a growing fiscal commitment. The state spends about ₹50 crore a year on average, while historical payouts have ranged from ₹36 crore to ₹72 crore. Following the increase in benefit limits in 2026, annual expenditure is expected to rise to around ₹75-85 crore or more.
How families use the scheme is equally revealing. The median cost of a treatment package is below ₹35,000, and more than 94% of families use less than ₹1.5 lakh in a year. General surgery, orthopaedics and ophthalmology account for much of the routine demand, while the larger bills tend to come from cardiac procedures, cancer treatment and complex urological care.
This helps put the ₹6 lakh ceiling in perspective. Most families will never need anything close to it, but that is not necessarily an argument for a lower limit. A family dealing with prolonged cancer treatment or major cardiac care can run through a smaller entitlement quickly. The higher ceiling therefore matters most in the relatively uncommon cases where the financial consequences of serious illness are greatest.
Goa is also integrating DDSSY with the Ayushman Bharat Digital Mission (ABDM), with Ayushman Bharat Health Accounts (ABHA) helping make health records, prescriptions and laboratory reports accessible across participating facilities. But the real test of the system begins when a patient arrives at a hospital and tries to use the assurance promised on paper.
Where Health Assurance Breaks Down
DDSSY’s broad reach is important, but the experience of using the scheme is not always as smooth as the enrolment numbers suggest. Some of the most persistent problems appear at the point of care, where digital verification, hospital participation and eligibility rules can determine whether a cashless entitlement actually translates into treatment.
The first weakness is administrative. DDSSY relies on digital authorisation, and reports have documented cases in which portal failures or delayed OTPs held up approval, including during emergencies. For a scheme designed to prevent families from paying upfront, such delays can be especially damaging. The problem is not the use of digital systems itself, but the lack of a dependable fallback when they fail.
Private hospitals face their own pressures. Some empanelled providers have reportedly refused DDSSY cards or limited beds for beneficiaries, citing delayed reimbursements and package rates that they say do not always match the cost of complex treatment. When these disputes are unresolved, the burden shifts back to the patient, who may have to find another hospital or pay unexpectedly out of pocket.
The five-year residency rule raises a different question. It makes DDSSY widely available to long-term residents, but excludes newer migrant workers in sectors such as hospitality, construction and seasonal employment. The rule may protect the state’s fiscal exposure, yet it also leaves some people who live and work in Goa outside its principal health assurance scheme.
Quality of care matters just as much as access. Goa could strengthen empanelment by tying it more closely to National Accreditation Board for Hospitals and Healthcare Providers (NABH) standards, while allowing smaller facilities time to upgrade. Clinical monitoring should also look beyond the number and value of claims to outcomes such as hospital-acquired infections, readmissions and mortality after specialised procedures. Verification, meanwhile, must remain rigorous without becoming intrusive; diagnostic records and authenticated clinical documentation offer a better basis for checks than photographs of wounds or intimate body parts. A stronger grievance mechanism through Goa Online could also give patients a clearer route to report poor care.
The larger point is simple: health assurance cannot be judged only by how many people hold a card. It has to work at the hospital desk, during treatment and through recovery.
Strengthening the Goa Model
Goa does not need to reproduce the much larger health assurance systems of other states, but some of their experience is worth adapting. One lesson concerns exceptionally expensive treatment. Even after the recent increase in DDSSY benefits, prolonged cancer care, organ transplants or neonatal intensive care can exhaust the available limit. Rajasthan offers one approach: a higher top-up reserved for rare and catastrophic illnesses, rather than raising the entitlement across all claims.
The range of treatment covered also deserves periodic review. DDSSY has 447 medical packages, compared with 1,100-1,700 under comparable schemes in Rajasthan and Tamil Nadu and more than 2,350 in Punjab. More packages do not automatically make a better scheme, but clinical experts within the Directorate of Health Services could use these lists to identify genuine gaps in Goa. Tamil Nadu offers another useful idea: allowing government hospitals to retain and reinvest part of the insurance reimbursement generated by the treatment they provide. At institutions such as Goa Medical College, this could support equipment and service improvements.
There is also a fiscal case for closing the remaining protection gap. An estimated 8-10% of the population remains uninsured because of renewal lapses or documentation and residency requirements. The original estimates put the additional annual cost at ₹35-43 crore: roughly ₹5-6 crore to absorb registration and renewal fees, ₹10-12 crore to bring currently uncovered households into the system, and ₹20-25 crore for the additional claims likely to follow. Against annual state expenditure of more than ₹28,000 crore, the total amounts to about 0.16% of Goa’s budget. This suggests that further expansion is fiscally manageable, although extending protection to those excluded by the five-year residency rule would still require a separate decision on eligibility.
Administrative reform could accompany that expansion. Linking DDSSY records with the electoral roll and Aadhaar could support more automatic enrolment and renewal for eligible residents, while a real-time e-KYC override could prevent OTP or documentation failures from delaying emergency care. Such linkage, however, cannot substitute for a separate route for residents who are not on the electoral roll or do not meet the residency threshold. Stronger taluka and sub-district facilities, better specialist availability, faster TPA claims processing, non-intrusive verification and periodic revision of package rates in line with clinical costs would address several of the problems patients and providers encounter today.
Making Health Assurance Count
Goa has come a long way from the days when families had to pay for treatment first and seek reimbursement later. DDSSY has widened access to cashless care, brought a large share of the state’s residents under health protection and, with the recent increase in benefit limits, offered families a bigger cushion against serious medical expenses.
But the next phase may prove harder. Spending more can help bring more people into the scheme, but it cannot fix an OTP that fails during an emergency, persuade a hospital to accept a card, improve poor-quality care or answer the question of what happens to workers who have not lived in Goa for five years. Those are the gaps that will determine how much DDSSY ultimately delivers.
That is also where Goa’s health story goes next. As the state looks towards Swayampurna Goa and Viksit Bharat @2047, the challenge is no longer simply to make the scheme bigger, but to make it work better—for the patient waiting for approval, the family facing an expensive diagnosis, and those who still remain outside its reach.
Goa already has much of the foundation in place. What matters now is whether it can turn health assurance from an entitlement people possess into a promise they can trust. In the end, the real measure of DDSSY will not be how many cards it issues or how high the ceiling rises, but what happens when a family walks into a hospital and needs that promise to hold.
About the Authors
Dr. Manorama Bakshi is Director & Head of Healthcare & Advocacy at Consocia Advisory, Founder & Director of the Triloki Raj Foundation, and a Senior Visiting Fellow at IMPRI.
Dr. Arjun Kumar is the Director of the IMPRI Impact and Policy Research Institute, New Delhi. He holds a Ph.D. in Economics from the Centre for the Study of Regional Development, School of Social Sciences, Jawaharlal Nehru University (JNU), New Delhi.
Disclaimer: All views expressed in the article belong solely to the author and not necessarily to the organisation.
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Acknowledgement: This article was posted by Pallavi Lad, a Research and Editorial Intern at IMPRI.
