The scheme which is completing five months, has attracted much attention from across India. Modi reiterated that AB-PMJAY highlighted his government’s emphasis on the health sector and was a big step to ensure universal health coverage for the masses.
The Union health ministry claimed that so far more than 900,000 patients have availed treatment worth ₹1,338 crore under the scheme.
The next step for providing quality and universal health coverage is also being debted.
AB-PMJAY, dubbed ‘Modicare’ and labelled as the world’s largest health insurance scheme, aims to provide health cover for secondary and tertiary hospitalisation to nearly 40% of the population, or more than 100 million poor and vulnerable households, based on the socio-economic caste census (SECC) database. The premium is paid by the government and the scheme offers a health cover of ₹5 lakh per family per year.
A research paper published in the latest issue of Indian Journal of Public Health, which used the National Sample Survey Office (NSSO) data released in 2015, revealed that ailing people account for 8.9% and 11.8% of the rural and urban population, respectively, while a majority did not have any health cover.
“Although infrastructure in urban India fares better than that found in rural areas, it is still largely dependent on the level of living of the family. The percentage distribution of sources of finance for hospitalised treatment captures only a part of the picture and does not fully describe the complexity of issues," said Shri Mukesh, joint director, National Sample Survey Office (Coordination and Publication Division), Ministry of Statistics and Programme Implementation, who is also the author of the research paper.
“It is also important to measure other socioeconomic aspects and issues related to governance and policy, which capture the multi-dimensional nature of health financing in India," he added.
Considering the very low penetration of health insurance in India, out-of-pocket spending for healthcare services is very high. For effective population management, experts said that universal health insurance will act as a powerful catalyst. They also said that to create a robust healthcare ecosystem and take AB-PMJAY to the next level, the government should make health insurance mandatory for all in a phased manner.
“The major reason for the low penetration of health insurance is because it is currently optional. While the government has taken laudable steps to introduce a health insurance scheme for the weaker section with AB-PMJAY, the government could also explore making health insurance coverage mandatory for all citizens," said Siddhartha Bhattacharya, secretary general, NATHEALTH, a healthcare service provider. “Starting with organized sector, employees could be given the option to either pay their employees’ state insurance (ESI) contribution or purchasing insurance from any Insurance Regulatory and Development Authority (IRDA)-regulated insurer. Scaling up PMJAY to all citizens, including middle and upper middle class, needs to be done in the next phase."
As India drives towards making healthcare more accessible, affordable and inclusive, quality will be key, given that low-quality healthcare, if scaled, can set the clock back.
“Quality improvement in India will require a dedicated authority to develop policy framework to support quality measurement and improvement strategies," said Krishna Reddy, country director, ACCESS Health International, an advisory and implementation partner.