From Insurance-Driven Private Health Care to Equity, Pg8

• India’s Healthcare Model:
  • Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) focuses on reducing out-of-pocket expenditure (OOPE) but mainly covers tertiary care (hospitalization, surgeries).
  • Neglects primary health care (PHC), which is crucial for preventive and community-based health systems.
• Concerns with Insurance-Based Model:
  • Privatization & foreign investments in insurance have increased, shifting the burden from public to private players.
  • Healthcare becomes capital-driven, leading to high health costs, exclusion of vulnerable groups, and greater inequality.
• Policy Gaps & Informal Sector Exclusion:
  • Informal workforce (450+ million) lacks formal insurance access.
  • Lack of community-based health initiatives leads to dependency on tertiary and private hospitals.
• Lessons from Global Models:
  • Thailand & Costa Rica successfully use public funding for universal health coverage, preventing insurance-driven health cost inflation.
  • The U.S. model shows risks of corporate control over healthcare, leading to high costs and inequality.
• Way Forward for India:
  • Strengthening public health investment in PHC and community-based care.
  • Comprehensive health benefit packages to cover vulnerable populations.
  • Policy interventions to cap insurance-driven cost inflation and ensure affordability.

Mains Mock Question:

"Critically analyze the shift towards an insurance-based healthcare system in India. Discuss its impact on equity and accessibility and suggest measures to strengthen primary health care in the country."