Source: TH
Context:
The debate on India’s Universal Health Care (UHC) has intensified with rising budgets for Ayushman Bharat–PMJAY and State Health Insurance Programmes (SHIPs). The Bhore Committee Report (1946) laid the foundation for Universal Health Care (UHC) in India, advocating a publicly funded, comprehensive health system.
Growth of Health Insurance in India:
- PMJAY (2018): Provides ₹5 lakh cover per household annually, covering 58.8 crore individuals (2023–24).
- State Health Insurance Programmes (SHIPs): Parallel state schemes cover a similar population with ~₹16,000 crore budget.
- Combined Annual Expenditure: ~₹28,000 crore, rising 8–25% (2018–2024).
- Utilisation Gap: Despite wide coverage, only 35% of insured hospital patients could use schemes (HCES 2022–23).
Fault Lines in Insurance Expansion:
- For-Profit Bias: Nearly two-thirds of PMJAY funds flow to private hospitals, leading to overcharging and unnecessary procedures.
- Neglect of Primary Care: Focus on hospitalisation diverts funds from PHCs, diagnostics, and preventive care.
- Utilisation Barriers: Awareness gaps, low reimbursement rates, and hospital reluctance restrict access.
- Discrimination: Public hospitals prefer insured patients; private hospitals prefer uninsured ones for higher billing.
- Financial Strain: Pending dues under PMJAY (₹12,161 crore) exceed budget; over 600 hospitals exited due to delayed reimbursements.
- Fraud Risks: NHA flagged 3,200 hospitals for fraudulent claims, ghost patients, and inflated bills.
Structural Risks for UHC:
- Public health expenditure remains 1.3% of GDP (vs global average 6.1%).
- Insurance reinforces private dominance without solving systemic quality gaps.
- Out-of-pocket (OOP) spending in India remains among the highest globally.
International Comparisons:
- Thailand, Canada: Successful UHC relies on non-profit providers, universal funding, and strong regulation.
- India’s Model: Targeted, profit-oriented, with weak regulatory oversight.
Way Forward:
- Strengthen public health infrastructure (PHCs, diagnostics, rural workforce).
- Prioritise preventive and primary care over hospitalisation-focused funding.
- Regulate private sector with price caps, standard treatment protocols, and strict audits.
- Improve beneficiary awareness, digital literacy, and grievance redressal.
- Ensure timely reimbursements and explore direct budgetary allocations.
- Raise public health spending to 2.5% of GDP as per National Health Policy 2017 target.
