Guest Author: Hannah Miller

Last January I arrived in Dharamsala, a small city in India’s northwest state of Himachal Pradesh. Along with fifteen other American students I was there to study Tibetan culture, history, language and Buddhism. We spent the semester studying these subjects at two Tibetan colleges in Dharamsala, while living with Tibetan roommates and host families. At the end of the semester, we were given three weeks to conduct an independent research project of our choice. At my college in the United States I am majoring in Global Health, so I wanted to pursue a project related to public health in the Tibetan exile community in India.

Prior to 2012, there was almost no use of health insurance in the Tibetan exile community. The Tibetan government in exile provided reimbursement for healthcare costs on a case-by-case basis to Tibetans living in India, but could not afford to provide coverage for all who needed it.

In 2012, the Tibetan exile government introduced the Tibetan Medicare System (TMS), which began providing coverage for inpatient expenses to Tibetan families and individuals. The system was developed through a partnership between the Central Tibetan Administration’s Department of Health and the Micro Insurance Academy (MIA), an NGO based in New Delhi, India. The program is open to any Tibetan individuals and families living in India. For an individual, it costs 950 INR per year to enroll, and 3565 INR per year for a family of two to five people. The insurance can be used at an extensive list of hospitals to cover inpatient expenses up to 50,000 INR or 100,000 INR per year for individuals and families, respectively.

The introduction of this insurance marks great progress for healthcare in the Tibetan exile community. As part of my research, I interviewed community health workers in two Tibetan settlements in Himachal Pradesh.

In a small settlement in Kullu, Himachal Pradesh, I met Passang, the local community health worker. She explained that before the introduction of TMS, many people in her community struggled to afford expensive medical treatment. The previous year, two community members were diagnosed with cancer, but could not afford treatment, so died without receiving care. TMS will hopefully help to prevent unnecessary deaths like those in Kullu. While it is still too early to tell the long-term effects of TMS, it is clear that it is a great improvement over the previous system.

As an American who has grown up with a market-based healthcare system since birth, it is refreshing to come across the Tibetan Medicare System, which seeks to provide health insurance to the community without making a profit. Throughout my research, both people in the government and members of the Tibetan exile community repeatedly emphasized the importance of creating the insurance for the good of the community. While initial enrollment in the program was not as high as expected, support of the program will likely grow as people notice its success. As the system grows, I have high hopes for its success and ability to create change in the Tibetan exile community.

If you are interested in the TMS or the Tibetan exile community in general, please comment on this post and I can direct you to more resources.