Paper: GS – II, Subject: Governance, Topic: Government Policies – Health, Issue: PM-JAY Scheme– Bridging India’s Healthcare Divide.
Context:
The latest Household Social Consumption (Health) Survey by NSO highlights that while health insurance coverage has expanded significantly after PM-JAY Scheme, actual access to healthcare and financial protection remains uneven, especially for serious illnesses.
Key Takeaways:
Background:
Explanation:
1. Insurance Expansion vs Limited Access:
Insurance coverage has increased sharply post-PM-JAY, improving financial protection.
However, hospitalisation rates remain below 2014 levels, showing that coverage ≠access.
Barriers persist due to limited facilities, hidden costs, and uneven service availability.
2. Public Financing, Private Provision:
PM-JAY and state schemes now finance a larger share of hospital care.
But low reimbursement rates lead private hospitals to:
Charge for diagnostics, medicines, and ancillary services separately
Result: Public insurance often subsidises private healthcare without full price regulation.
3. Changing Disease Burden:
Increase in reported illness reflects better healthcare-seeking behaviour.
Shift observed:
Decline in infectious diseases
Rise in non-communicable diseases (NCDs)
Requires stronger systems for long-term and chronic care, not just hospitalisation.
4. OOPE Trends: Mixed Outcomes:
Median OOPE has declined (~₹11,285 per hospitalisation) and is minimal in public outpatient care.
Public sector and schemes like AAM reduce routine costs.
However, high-cost treatments (surgeries, chronic diseases) still cause catastrophic expenditure.
5. Structural Weakness in Health System:
Public sector effectively supports primary and secondary care.
But:
Underfunding for chronic disease management
Private dominance in tertiary care
Outcome:
Poor → nominal coverage but limited real benefit
Middle class → high financial burden in serious illness
6. Core Issue:
India has improved:
Insurance coverage
Basic affordability
But lacks:
Adequate public hospital capacity, especially for advanced care
Thus, access inequality persists despite coverage expansion.
7. Way Forward:
Strengthen public sector hospital capacity, particularly tertiary care
Reduce dependence on private providers
Ensure actual service delivery matches insurance coverage
Conclusion:
India’s health reforms have expanded insurance and improved affordability at basic levels, but true universal healthcare requires strong public hospitals. Without this, financial protection remains incomplete and inequalities persist.
Source: (The Hindu)
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