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

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Estimates of Health Insurance Coverage in India

Financing health expenditure through health insurance is currently gaining significance as a strong social policy in countries like India where public health facilities are still inadequate. An attempt to estimate the coverage of health insurance in India shows that the coverage is low and not uniform across states and union territories, despite the fact that several public-funded schemes focus on the below poverty line population. Of the various types of health insurance schemes, public-funded health insurance schemes have a dominant position. Moreover, the likelihood of health insurance coverage is relatively higher among specific social groups and in certain areas.

Invest More in Public Healthcare Facilities

Data from National Sample Surveys (71st round, 2014 and 75th round, 2017–18) show that there is a significant increase in the utilisation of public facilities for both outpatient and inpatient services, across empowered action group states and non-EAG states. As a result, there is a dramatic fall in the overall financial burden on patients who would have otherwise used services of private healthcare providers. In light of this evidence, this paper argues that it is prudent to invest more directly to strengthen public healthcare delivery system in India.

Emerging Governmentality and Biopolitics of COVID-19 in India

Measures like disciplining and quarantining are associated with the governments’ extraordinary powers during unprecedented times. In this context, the biopolitics of the ongoing COVID-19 pandemic is discussed. When the steps taken by the government to contain the spread of coronavirus are failing, we need new imageries to tackle the challenges that lie ahead of us.

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.

Need for a Strong and Reliable Statistical System in India

The evolution and organisation of the Indian statistical system is reviewed with particular emphasis on social sector statistics. In the light of recent experiences during the COVID-19 pandemic, some evident lacunae in the system of collecting, synchronising, and disseminating data from diverse sources are discussed. The critical need for better financing of the statistical agencies, facilitating homogeneous integration between different agencies, and promoting transparency, accountability, and autonomy of the statistical system are highlighted as key priorities.

Underestimation of the COVID-19 Burden

The number infected with SARS-CoV-2 in early May in India is estimated by a method utilising the unequivocal number available, namely deaths due to COVID-19. The estimated numbers are far in excess of reported numbers and indicate the systemic flaws in reporting deaths in India, augmenting the extent of underestimation. Additionally, there is the overestimation of the doubling time of infection. A realistic picture of the epidemic at the community level is presented, which informs us about the level of preparedness required to deal effectively with the epidemic.

COVID-19 and Dwindling Indian Federalism

One of the many effects of COVID-19 pandemic disaster is also visible on legislative, executive and financial federalism in India. The constitutional mandate for functioning of centre on behalf of states has been missed and recourse to disaster has been taken to undertake unified but unconsented measures.

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.

National Medical Commission Act, 2019

The relevance, provisions and the implications of the National Medical Commission Act, 2019 for the future of medical education and health practice in the country are examined here. This act is a step towards improving governance and introducing reforms with the potential to create an enabling environment, and facilitate standardisation in processes and transparency in the functioning of the health sector.

National Medical Commission Act

The National Medical Commission Act, passed by Parliament in July 2019, has been billed by the government as the “biggest reform” in the medical profession and a “pro-poor legislation” that shall make quality medical care more accessible to the people. Paradoxically enough, the act ran into severe resistance from the very profession whose lot it was supposed to improve. An examination of some of the provisions of the act in light of these developments makes us think that the act may well be a case of the cure being worse than the malady itself. There is a need for the resistance against this act to be revived.

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