Comprehensive Survey on Health Insurance and Social Consumption
The 80th round of the household social consumption (health) survey by the National Statistical Office marks a significant analysis post-pandemic and during the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY) maturation.
Key Findings
- Insurance Coverage Expansion:
The survey reveals a threefold increase in insurance coverage since the PMJAY's 2018 launch, contributing significantly to hospital financing. - Hospitalisation Rate:
The rate has not yet returned to 2014 levels, indicating that insurance does not always guarantee access to hospital care. Reimbursement rates often fall below market standards, leading private hospitals to charge separately for diagnostics. - Population Health Trends:
- The Proportion of Population Reported Ailing has doubled.
- Infectious diseases have decreased while non-communicable diseases have risen.
- Out-of-Pocket Expenses (OOPE):
The mean OOPE has doubled, but the median has dropped to ₹11,285 per hospitalisation, nearly negligible for public outpatient care. This highlights affordable care through the public sector, though significant expenses remain a risk.
Challenges and Areas for Reform
- Underfunded AAM Network:
The Ayushman Bharat network, crucial for free medicines and diagnostics, is underfunded, especially for chronic disease management where the private sector is dominant. - Coverage Inequality:
The poor often face exclusion from practical benefits of coverage despite nominal insurance, while the middle class experiences rising catastrophic expenses. - Future Reforms:
Healthcare reform should focus on enhancing public sector hospital capacities to provide competitive tertiary care, aiming to protect care-seekers from poverty and facilitate near-universal delivery.
