Health Insurance for India’s Missing Middle

Recently, NITI Aayog in a report titled ‘Health Insurance for India’s Missing Middle’ suggested extending Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) coverage to ‘missing middle’.

Context

Recently, NITI Aayog in a report titled ‘Health Insurance for India’s Missing Middle’ suggested extending Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) coverage to ‘missing middle’.

Key-highlights of the Report

• Around 20 per cent of the population -- 25 crore individuals are covered through social health insurance, and private voluntary health insurance.
• The remaining 30 per cent of the population is devoid of health insurance.
• The actual uncovered population is higher due to the existing coverage gaps in PM-JAY and overlap between schemes.

About AB-PMJAY

• It is a Centrally Sponsored Scheme and the nodal agency to implement it is the National Health Authority (NHA).
• PMJAY provides cashless and paperless access to services for the beneficiary at the point of service.
• 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 is 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.

Challenges in health sector for middle class

• Expensive treatment
• Lack of access to proper healthcare
• Unawareness
• Inadequate reach
• Inadequate Fund
• Optimal Insurance
• No focus on Preventive Care
• Shortage of Medical Workforce
• Inadequate outlay for health
• Lack of structure

Important Government on Health

• National Food Security Act (NFSA)
• Pradhan Mantri Suraksha Bima Yojana
• Pradhan Mantri Kisan Samman Nidhi (PM-KISAN)
• Aam Aadmi Bima Yojana