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

In News

• 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.

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