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NITI Aayog soon to come out with final report on health coverage for the missing middle

Gireesh Babu, New Delhi
Tuesday, March 14, 2023, 08:00 Hrs  [IST]

A multi-stakeholder committee of the central government’s policy think tank NITI Aayog is in the process of preparing the final report for a larger health insurance coverage to improve the healthcare affordability in the country.

The committee is assigned to device a policy and strategy to extend or expand the health coverage to the ‘missing middle’ - the broad category of population which lacks health insurance, positioned between the deprived poorer sections and the relatively well-off organised sector.

The think tank is also in the process of refining a scheme to improve the emergency care and trauma care system under the Ayushman Bharat programme, after conducting a 100-facility study with All India Institute of Medical Sciences (AIIMS), New Delhi, to assess the current state of emergency care.

NITI Aayog had released the report in October, 2021, on Health Insurance for India’s Missing Middle, bringing out the gaps in the health insurance coverage across the Indian population and offering solutions to address the situation.

Following the release of this report, the National Health Authority requested NITI Aayog to suggest a strategy to extend the health coverage to the missing middle and a multi-stakeholders committee with the Special Secretary of NITI Aayog as Chair, was constituted with members from the ministry of health and family welfare (MoHFW), National Health Authority and others including from the insurance sector.

The Committee was tasked with responsibilities including devising a policy and strategy to extend or expand the health coverage to the missing middle under the ambit of Pradhan Mantri Jan Arogya Yojana (PMJAY) or independent of it; devising the criteria for identification of the missing middle as an individual or group and strategise a mechanism for their plausible enrollment or subscription for these; suggesting ways for effective distribution, raising consumer awareness of health insurance; and suggesting implementation pathways for extending coverage to missing middle.

“The Committee has organized several stakeholder deliberations, and the final report is under preparation,” said NITI Aayog’s Annual Report for the year 2022-23.

The report released in October, 2021, said that the Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana—a flagship scheme towards Universal Health Coverage, and State Government extension schemes—provides comprehensive hospitalization cover to the bottom 50% of the population. Around 20% of the population is covered through social health insurance, and private voluntary health insurance primarily designed for high-income groups. The remaining 30% of the population, devoid of health insurance, is termed as the “missing middle.” The missing middle contains multiple groups across all expenditure quintiles and is spread across both urban and rural areas.

The report highlights the need for designing a low-cost comprehensive health insurance product for the missing middle. It primarily recognizes the policy issue of low financial protection for health for the missing middle segment and highlights health insurance as a potential pathway in addressing that. In doing so, the report offers a starting point for broader discussions on solutions, and specific products, to improve insurance coverage for the missing middle.

It also proposed a wider industry and government stakeholder consultations, and discussion with consumer groups to delve deeper into the specifics of the problem, and potential solutions.

NITI Aayog, in its Annual Report released recently, also said that it is working towards addressing the issues related to the emergency and trauma care system in a comprehensive manner, highlighting the need for a strong, holistic ambulance–emergency–trauma care system.

“India witnesses a huge burden of emergency and trauma cases, composed of a high proportion of the young, who are often the sole bread-earners and inflicts high out-of-pocket-expenditure, adding urgency to address these health issues. Addressing these issues would also contribute towards achieving multiple Sustainable Development Goal (SDG) targets, including halving the number of global deaths and injuries from road- traffic accidents by 2030 and also cover emergencies arising due to obstetrics, pediatrics, infections, NCDs and disasters,” it said.

NITI Aayog has been working on the scheme along with MoHFW, and ministry of road transport and highways (MoRTH) and other stakeholders, and conducted a 100-facility study with AIIMS, New Delhi to assess the current state of emergency care, besides studying models in various states and other countries, embracing WHO recommendations.

“Multiple high-level presentations on this scheme have been made, involving the highest offices, wherein it has found traction and is under further refinement for better adaptation,” added the Annual Report.


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