According to a report by Niti Aayog, in the absence of low-cost health insurance products, at least 30 per cent of India’s population or 40 crore individual is devoid of any financial protection through insurance. The report titled ‘Health Insurance for India’s Missing Medium’ said that expanding health insurance coverage is a necessary step and path in India’s efforts to achieve universal health coverage (UHC).

“At least 30 percent of the population, or 40 crore individuals called the missing mean in this report, is devoid of any financial health protection… In the absence of a low-cost health insurance product, the missing mean remains exposed despite the ability to That the “missing middle” is a broad category that lacks health insurance, lies between the disadvantaged poor, and the relatively affluent organized sector.Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) Launched in September 2018, state government extension schemes provide comprehensive hospitalization coverage for the lowest 50 per cent of the population is about 70 crore individuals. About 20 per cent of the population is 25 crore individuals is covered by social health insurance and private voluntary health insurance.” The remaining 30 per cent of the population is free of health insurance; The population covered is higher due to current coverage gaps in PMJAY and overlap between the schemes.

“This uncapped group is called the missing medium,” the report said. The report noted that the missing mean is not a monolith, it contains multiple clusters across all spending quintiles. rural areas, though they are concentrated in the first two-fifths in rural areas, and the highest three-fifths in urban areas.”

According to the report, the missing middle is mostly the informal self-employment sector (agricultural and non-agricultural) in rural areas, and a wide range of informal, semi-formal and formal occupations in urban areas. Noting that most health insurance plans and products in the Indian market are not designed for the missing medium, the report said that private voluntary health insurance is designed for high-income groups, and costs at least two to three times the affordable level of the missing medium. Affordable contribution products such as ESIC and government-backed insurance including PMJAY are closed products, the report said, adding: “They are not available to the general population due to adverse selection risks.” Niti Aayog (Health) member VK Paul, in the foreword to the report, highlighted the need for health insurance coverage for all and said, “There are significant challenges to be overcome to increase health insurance penetration.” He added that the government and the private sector need to work together in this endeavour. “The ingenuity and competence of the private sector is required to get into the missing middle and deliver compelling products,” Paul said.

The report stated that low government spending on health has limited the capacity and quality of health care services in the public sector. “It turns the majority of individuals around two-thirds to seek treatment in the more expensive private sector,” the report said, adding that lower financial protections lead to higher personal spending. Catastrophic spending, poverty from exorbitant trips to hospitals and other health facilities.

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