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Health Insurance for India’s Missing Middle

  • Category
    Polity & Governance
  • Published
    8th Nov, 2021

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

Right to Health in India

  • Articles 39, 41, 42 and 47 in the Directive Principles of State Policy (DPSP) contain provisions regarding Health.
  • Article 21 provides for the right to life and personal liberty and is a fundamental right.
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