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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.
- Though this model ensures coverage of the poorer segments of the missing middle population
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)
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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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