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Towards a healthy India: there is a ‘missing middle’ in terms of health insurance penetration

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In addition to the development of the health ecosystem, its regulation is just as important.

By Abinash Dash and Ashwani Aggarwal

The FY22 budget gave top priority to the health sector in an unprecedented way. Most importantly, he recognized the links between health and nutrition, water and sanitation facilities that are mutually reinforcing. The allocation for the health and welfare sector increased mainly due to the increase in the allocation for water and sanitation which went from Rs 21,500 crore to Rs 60,000 crore, grants from the Finance Commission and Rs 35,000 crore for the Covid-19 vaccination. However, the allocation to the basic health sector, including health research and AYUSH, only registered an 11% increase in its allocation compared to 2020-2021 BE.

The launch of PM Atmanirbhar Swasth Bharat Yojana (PM-ANSBY), with an expenditure of Rs 64,180 crore over six years, which aims to develop capacities at different levels of the health system and create new institutions and strengthen existing ones, is a giant steps to strengthen the health system in the country. However, the budget allocation for the National Rural Health Mission (NRHM) – which is at the heart of the National Health Mission (NHM) – in 2021-2022 BE recoded a growth of 11% compared to 2020-2021 BE and remains unchanged from Actual Reports 2019-2020. A phased introduction of PM-ANSBY with increased allocation for NHM in the early years would facilitate program deployment as the existing health ecosystem has two operational flagship programs – NHM and Ayushman Bharat – focused on health dimensions similar.

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In addition to the development of the health ecosystem, its regulation is just as important. Regulation of the health sector for quality, quality of care, evaluation of service providers and hospitals and accountability is crucial for the health sector. An effective and efficient regulatory infrastructure is urgently needed in the health sector. The budget for fiscal year 22 mentions the introduction of the related health services bill which has been introduced and the nursing and midwifery bill will be introduced shortly. Besides these bills, there are several other medical services like dentistry and pharmacists etc. which fall under different laws, rules and regulations. There is a multiplicity of laws, rules and regulations and a proliferation of institutions, but regulation of the sector is far from adequate. As such, there is a need to rationalize, standardize medical services and develop a comprehensive health code (HCC) for the health ecosystem on similar lines as announced in the securities markets budget. securities (Securities Market Code). In addition, to provide evidence-based advice, develop quality standards and provide information to stakeholders involved in the health sector, a national institute should be established, similar to the National Institute for Excellence in health and care in the UK.

In addition, the “missing middle” in terms of growing insurance penetration has become predominant. While PMJAY covers the bottom two income quintiles, commercial insurance largely covers the top income quintile, creating a “missing” middle class in between. These are the people in the two middle income quintiles, where the population is not rich enough to pay for commercial insurance and not poor enough to be covered by government funded health insurance plans. The universalization of health insurance is the ultimate goal which has no exclusion in terms of illness or category of persons.

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Health infrastructure in level 2 and 3 cities is a major bottleneck. Support for existing small hospitals to increase the size of hospitals should be provided, for example, by providing them with an easy line of credit. Technical support to small hospitals to standardize and outsource backend functions like procurement, engagement with insurance companies, financial activities, etc., is needed. In addition, the establishment of a one-stop-shop, compared to the numerous authorizations currently required, would generate more investment and stimulate private-public partnership.

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In addition, the health sector is in dire need of a health development finance institution (DFI). The FY22 budget mentioned the establishment of a DFI to stimulate investments with an initial body of Rs 20,000 crore. The need for a specific DFI for the health sector is very necessary, as is the need for DFIs for other sectors such as NABARD (agriculture), NHB (housing) and TFCI (tourism). Such a health sector DFI would increase access to health care in Tier 2 and 3 cities and also benefit from technical assistance to ensure appropriate use of funds.

Ensuring effective monitoring and quality of health services would require intensive use of information and communication technologies (ICT). The availability of physicians should be monitored in real time to combat absenteeism and the use of the patient feedback mechanism to improve the quality of care in public health facilities, especially in rural areas. This could be done by taking advantage of the mobile penetration in the country.

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The increase in healthcare spending, the creation of DFIs in the healthcare sector, the reduction in the compliance burden, the increased use of ICT and universal health insurance as well as adequate regulatory oversight by the Through a national health sector regulatory body / institute are the key to building a robust health ecosystem in India. The fiscal year 22 budget got off to an optimistic start on this front which must be postponed. The battle is won; the war must also be won.

Dash is Co-Director of the Economics Department and Aggarwal is Associate Director of PwC. Opinions are personal

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