Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY)

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    • NITI Aayog suggests extending Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) coverage to ‘missing middle’.
      • The report has recommended three models for increasing the health insurance coverage in the country.

    NITI Aayog report’s ‘Health Insurance for India’s Missing Middle’ 

    • The AB-PMJAY and State Government extension schemes provide comprehensive hospitalization cover to the bottom 50% population ( 70 crore individuals). 
      • Around 20% of the population are covered through social health insurance and private voluntary health insurance. 
      • The remaining 30% of the population is devoid of health insurance; the actual uncovered population is higher due to existing coverage gaps in PMJAY and overlap between schemes.

    Recommendations of the report 

    • The report has recommended three models for increasing the health insurance coverage in the country. 
      • The first model focuses on increasing consumer awareness of health insurance.
      • The second model is about developing a modified, standardized health insurance product like ‘Arogya Sanjeevani’
        • a standardised health insurance product launched by the Insurance Regulatory Development Authority of India (IRDAI) in April 2020.
      • The third model expands government-subsidized health insurance through the PMJAY scheme to a wider set of beneficiaries. 
    • Focus
      • In the short term, the focus should be on expanding private voluntary insurance through commercial insurers. 
      • In the medium-term, once the supply-side and utilization of PMJAY and ESIC is strengthened.
        • Their infrastructure can be leveraged to allow voluntary contributions to a PMJAY plus product, or to ESIC’s existing medical benefits. 
    • In the long-term, once the low-cost voluntary contributory health insurance market is developed.
      • Expansion of PMJAY to the uncovered poorer segments of the missing middle should be considered
    • Ease the identification of, and outreach
      • Information sharing of the government scheme data with the private insurance companies. 
      • Government databases will help ease the identification of, and outreach to potential customers by insurers.
        • But only after taking consent from these households suggesting an outreach strategy.
      • Databases to be shared can be  
        • National Food Security Act (NFSA), 
        • Pradhan Mantri Suraksha Bima Yojana, 
        • The Pradhan Mantri Kisan Samman Nidhi (PM-KISAN) 

    About the third model

    • This model can be utilized for segments that remain uncovered.
      • Due to limited ability to pay for the voluntary contributory models.
    • The modified product should have lower waiting periods. 
    • It should also include outpatient benefits through a subscription model to increase the value of healthcare provided.
    • This is the only model out of three proposed which has financial implications for the Government. 
      • Though this model ensures coverage of the poorer segments of the missing middle population
        • Premature expansion of PMJAY can overburden the scheme.

    Why add the missing middle?

    • The missing middle is nothing but those families that are devoid of any financial protection for health.
      • It includes at least 30 per cent of the population, or 40 crore individuals.
    • A slightly modified version of the Aarogya Sanjeevani insurance product will help increase the reach amongst the missing middle.

    Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) 

    • It offers a sum insured of Rs.5 lakh per family for secondary care as well as tertiary care.
    • Cashless and paperless access to services is provided to the beneficiaries at the point of service.
    • The Health Benefits Packages covers surgery, medical and daycare treatments, the cost of medicines and diagnostics.
    • Beneficiaries will be identified by the latest Socio-Economic Caste Census (SECC) data.
    • It is a Centrally Sponsored Scheme
    • The Nodal Agency National Health Authority (NHA).
      • It has been constituted as an autonomous entity under the Society Registration Act, 1860 for effective implementation of PM-JAY.
    • The State Health Agency (SHA) is the apex body of the State Government responsible for the implementation of AB PM-JAY in the State.

    Way Ahead

    • Universal Health Coverage (UHC)
      • The scalability of  the Ayushman Bharat needs to be improved further which can be done through the recommendations made by NITI Aayog.
      • AB-PMJAY programme has a vast ambition that creates an opportunity to pursue the systemic reform that India requires to meet it’s (UHC).
    • Public Expenditure on Health 
      • Injection of resources into a chronically underfunded health system.
      • India spent 1.8% of its GDP on health in FY 2020-21 as compared with 
        • the OECD countries’ average of 7.6% and 
        • other BRICS countries’ average of 3.6% on their health sector.
      • As a result, India is among the top nations with the highest Out Of Pocket Expenditure (OOPE).
        • Out of pocket expenses in healthcare in India hover close to 62%, nearly thrice the global average of 18%.
    • Technology-driven Governance
      • Focus on other interrelated issues like quality control, and stewardship if the scheme is to sustainably accelerate India towards UHC.
      • Using AI-powered mobile applications will provide high-quality, low-cost, patient-centric solutions. 

    Source: IE

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