ISSN (Print) - 0012-9976 | ISSN (Online) - 2349-8846

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Risky Insurance: The Pradhan Mantri Jan Arogya Yojana in Jharkhand

A ground-level survey of the Pradhan Mantri Jan Arogya Yojana in Jharkhand reveals that the scheme nudges patients towards the private sector under the guise of free healthcare only for them to incur exorbitant expenditure over the course of treatment.

Analysis of Private Healthcare Providers

India’s health system is dominated by the private sector and as a result, out-of-pocket expenditure is very high. To provide financial risk protection and avoid catastrophic health consequences, policy emphasis is on the Ayushman Bharat programme which targets to cover 50 crore people. Such a large-scale insurance scheme needs huge infrastructural and administrative support. Unincorporated private healthcare providers comprise 99% of private health providers in India, the majority of them being small scale, employing less than 10 workers and having a strong urban bias. To better promote universal health coverage, policy emphasis on better monitoring, administering regulations, transparency in system, and ensuring quality in delivery of service is needed.

Ayushman Bharat

The Pradhan Mantri Jan Arogya Yojana is an ambitious health insurance scheme that has been touted as an important tool to achieve universal health coverage. However, there is still no clarity regarding the financial implications of this scheme. Based on National Sample Survey data of 2004 and 2014 on hospitalisation rates and average medical expenditures, three alternate scenarios have been analysed based on different assumptions about these two parameters, to estimate the total costs of the programme. The results indicate a potentially high burden of the programme on the state and union government finances, especially if it is successful in covering all the intended beneficiaries.

Ayushman Bharat and the False Promise of Universal Healthcare

What implications will a health insurance scheme that relies on private capital have for India’s healthcare system?

Decoding Ayushman Bharat

The challenges before the components of Ayushman Bharat, the (ir)rationality behind raising the insurance coverage manifold are highlighted, a political economy narrative of the changing health financing scenario is drawn, and how the design of Ayushman Bharat will feed into executing the proposed public–private partnership model in public facilities and facilitate the strategic purchasing agenda of the National Health Policy is examined. Ayushman Bharat is a step towards creating a system that would facilitate in relinquishing public funds and public institutions to already dominant private players, which will have serious implications for the healthcare delivery system in India.

Health Insurance in Private Hospitals

Private hospitals are expected to play a key role in the implementation of government-sponsored health insurance schemes in India. Examining the availability and spread of private hospitals in the country and an analysis of their empanelment in government-sponsored health insurance schemes reveal that in low-income states of the country, empanelment of private hospitals by insurance companies is low and concentrated in a few pockets. This may indicate differences in entry conditions or low willingness of private hospitals to participate in these schemes, which has implications for the access to healthcare and insurance for the poor.

Ayushman Bharat

Taking into consideration the model of the Ayushman Bharat–Pradhan Mantri Jan Arogya Yojana, some valid questions regarding the operationality and feasibility of the scheme are examined. The shortcomings of the scheme are brought forth and a solution is offered so that the scheme does not stand in contradiction to various health schemes of the past.

How Equitable Will Ayushman Bharat Be?

Ayushman Bharat holds the promise to advance equity both within households as well as across social groups. However, the geographical inequities characteristic of India’s healthcare provisioning need to be overhauled first for the scheme to be more equitable.
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