The Niti Aayog report shows that Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) launched in September 2018, and state government extension schemes, provides comprehensive hospitalization coverage for the bottom 50 percent of the population – about 70 crore individuals.

health careIn other words, PMJAY in its current form should be opened to the entire population for primary and secondary coverage and people pay for it and for people to buy and not wait until tragedy strikes. (representative image)

If there was one big lesson from the debilitating impact of COVID-19 when the virus swept through India in April and May this year and cast disturbing images of corpses floating on rivers and those of mass cremations, that’s how – the insured could be severely damaged in Facing a major health crisis. So, with good reason, many experts and healthcare professionals have welcomed the new report from Niti Aayog, the Indian government’s research centre, on how India needs to meet the health coverage needs of what it calls India’s “missing middle”.

The Niti Aayog report shows that Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), which was launched in September 2018, and state government extension schemes, provides comprehensive hospitalization coverage for the bottom 50 percent of the population – about 70 crore individuals. About 20 percent of the population – 25 Crore individuals – is covered by social health insurance and private voluntary health insurance. The remaining 30 percent of the population is free of health insurance; The actual exposed population is higher due to current coverage gaps in PMJAY and overlap between the schemes. This uncapped group is called the missing medium.

He explains that the missing mean should not be viewed as a monolith because it contains multiple combinations across all five expenditure categories. The missing mean is spread across all spending quintiles, both in urban and rural areas, although it is concentrated in the top fifty in rural areas, and the top three-fifths in urban areas. The missing medium comprises mostly the informal self-employment sector (agricultural and non-agricultural) in rural areas, and a wide range of occupations – informal, semi-formal, and formal – in urban areas.

According to the report, “Most of the lost middle segments can pay Rs. 4,000 to Rs. 6,000 per family per year for hospital insurance – the rate indicated through industry consultancy – and Rs. 5,000 to cover outpatient benefits through the subscription form.”

While there is little doubt that the intent appears commendable and has been lauded by most who have looked at the challenges in Indian healthcare, much depends on the publication and the role the government will play.

The need to cover everyone

Nachiket Moore, visiting scientist at the Banyan Academy for Leadership in Mental Health, a former banker and someone who has looked at the Indian healthcare scenario closely and has written extensively on the matter, describes it as a step in the right direction. “On the journey to universal health coverage, this approach by NITI Aayog is a step in the right direction basically because India is a hugely underinsured market,” he says. But then, reflecting on the approach proposed in the Niti Aayog report, he feels that “the government should not delay in engaging the NHA (National Health Authority, responsible for PMJAY transplants) and not wait for the private sector to start implementing low-cost insurance products.” Instead, he argues, “NHA should offer some kind of PMJAY product to everyone immediately and everyone can pay premium and join without applying any income criterion. Instead of rolling registration, it can be limited to a fixed period once or twice a year, to reduce negative selection “.

Very rare and expensive procedures

He also noted that “the current PMJAY product, in which the government pays for a wide range of health care services in many hospitals for a limited population, could also be reconsidered.” He feels that “a product in which the government pays for a very narrow set of scarce and expensive inpatient services, in a limited number of specialty care hospitals, could instead be considered for the entire population.”

In other words, PMJAY in its current form should be opened to the entire population for primary and secondary coverage and people pay for it and for people to buy and not wait until tragedy strikes. This can be ensured by not having a rolling registration form but limiting it to registration at a specific time – either once or twice a year. Apart from this, a new PMJAY product has to be launched which is paid for by the government but is open to everyone in the country. But this should be limited to a few medical procedures which are very complex and very expensive procedures – for example, Rs 10 or higher which are available in a few specialist care hospitals but then are made available to all citizens. His views fall within the context of the report, which states that the primary focus and focus should be on expanding private voluntary contribution insurance through commercial insurance companies. All apparently, to help build a large and diverse risk pool at low premiums. Then, follow up on this by allowing “voluntary contributions to the PMJAY-plus product provided by the NHA, or to ESIC’s current medicinal benefits (in line with the product proposed in this report).”

Low cost supplemental insurance

In fact, Dr. Devi Shetty, Founder, President and CEO of Narayana Health and a longtime leading cardiac surgeon emphasized that there is a need in India to create a financial intermediary that offers low-cost health insurance and focuses on specific areas such as health insurance only for outpatients (Outpatient Department) or One is targeting only surgeries (such as Ayushman Bharat). But his view was that in addition to Ayushman Bharat, there should be additional low-cost insurance and the private sector should be encouraged to offer such low-cost insurance cover. not only insurance coverage but will also make Ayushman Bharat very attractive to hospitals and result in many beneficiaries of the programme.Dr Devi Shetty’s argument was that how can anyone earn Rs 60,000 a month, which is a small salary in itself, but perhaps a A challenge if he or she has to pay five days of ICU care for a relative.” “Our greatest strength is our numbers, so even if there is a small amount of premiums, it can be attractive because of the quantities. These payments can get health care providers a tax break. Once people realize that with Rs 500 per year of premium a person can be covered for X number of procedures or say if the first two days of ICU care are covered, there will be a cultural shift towards insurance in the state,” he feels. .

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