What does our health expenditure show?
India’s public healthcare spending is among the lowest in the world. Total health expenditure declined to 3.2% of GDP in 2018-19 from 3.3% in 2017-18, while the government’s health expenditure (centre and state) as a percentage of GDP fell from 1.35% to 1.28% in the same period. National health estimates showed the Centre’s share decreasing to 34.3% in 2018-19 from 40.8% in the previous year, while that of states rose from 59.2% to 65.7%. The silver lining? Out-of-pocket spending as a percentage of total health expenditure declined to 48.2% in 2018-19, though it is significantly higher than the world average of 18.1% in 2019
What about health insurance penetration?
With a population of 1.36 billion, India is the world’s second most populous country, and is expected to surpass China soon. Retail health insurance covers a meagre 3.2% of the country’s population. Launched in 2018 to provide universal health coverage, AB-PMJAY, takes care of the bottom 50% of the population of approximately 700 million individuals. The top 20% of the population is covered through social and private health insurance. Therefore, about 30% of the population, or about 400 million, is “the missing middle"— they don’t have any financial protection for health emergencies.
Why is sound healthcare important for the economy?
Covid-19 exposed the economic consequences of poor healthcare. Higher out-of-pocket healthcare spending hits savings and consumption. In the work space, poor health impacts physical and mental abilities, increase turnover and lead to lower productivity. Data shows that 7% of India’s population is pushed into poverty every year due to healthcare costs.
What is the status of the AB-PMJAY scheme?
AB-PMJAY aims to provide quality healthcare cover for the underprivileged. As per reports, 39.5 million hospital admissions, equal to ₹45,294 crore, have been undertaken till date. State governments have the flexibility to adopt a trust, insurance or a hybrid mode of implementation. A study found that while the trust mode has larger manpower requirements, scheme outputs were not necessarily higher. Beneficiary registration rate was higher in the case of insurance companies as against trust.
What are the gaps that need to be addressed?
Healthcare management and disease prevention should be the focus, along with all-encompassing healthcare system, including OPD. The government also needs to pay attention on healthcare cover for “the missing middle" population. As a pilot, states may allow the authority already implementing the AB-PMJAY scheme in the state to cover the missing middle. Familiarity about the prevalent ecosystem would result in economies of scale.
Jagadish Shettigar and Pooja Misra are faculty members at BIMTECH
