Page 221 - India Insurance Report 2023- BIMTECH

India Insurance Report - Series II 209

Universal Health Initiatives in India - To honor the commitment to the fundamental right of adequate
health to all its citizens and sustain its positive economic trajectory, India needs an Integrated National
Health System through the provision of universal health insurance (Reddy et al.,2020). The High-Level
Expert Group Report on Universal Health Coverage for India, Instituted by the Planning Commission
of India in 2011 while defining Universal Health Coverage, highlighted the availability of equitable
access for all Indian citizens to affordable, accountable, appropriate health services of assured quality. It
clarified that the assured quality should include promotive, preventive, curative, and rehabilitative care.
The report strongly advocated for public health services delivering the broader determinants of health
provided to individuals and populations through public and private collaborations. The report recommends
ten universal principles, highlighting community participation and putting health in people’s hands.
Community participation and people-centricity can be better achieved through emboldened primary health care.

The Health Policy 2017 (MOHFW, 2017) also recommended attaining the highest possible level of
health and well-being, preventive and promotive healthcare thrust, and universal access to good quality
healthcare services without any citizen facing any financial hardships. One of its core principles is
‘Pluralism’ which implies that Patients have the choice of traditional Indian medicine and access to
AYUSH care providers based on local, home, and community-based practices. The report recommended
robust integrative approaches.

The first concerted effort towards universal coverage in India started Rashtriya Swasthya Bima
Yojana (RSBY) in 2008 to fulfill the healthcare needs of the vulnerable BPL population. Until 2016, 41
million families were enrolled in RSBY, but the scheme failed to reduce the out-of-pocket expenditure
significantly (Gupta and Patel, 2021). The Government of India, on September 23, 2018, launched
Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) at Ranchi – the capital of
Jharkhand, covering secondary and tertiary care hospitalization of five lahks per family per year to
cover 12 crores poor and vulnerable families approximately 55 crore beneficiaries from that constitute
the bottom 40% of the Indian population based on the criteria of the Socio-Economic Caste Census
(SECC, 2011). PM-JAY will help mitigate the catastrophic expenditure on medical treatment that pushes
six crore Indians into the poverty trap each year. The scheme is comprehensive, covering three days of
pre-hospitalization, fifteen days of post-hospitalization expenses, and pre–existing conditions from day
one. As of April 2022, the scheme covers 1949 procedures with 27 specialities. The best part of the
scheme is that it encourages Public hospitals by reimbursing the healthcare services they provide at par
with the private hospitals. This is a bold move to revive the government hospitals. The expanse of the
scheme can be judged by looking at the 5,57,93,556 hospital admissions as of 30 August 2023 since the
launch of this scheme. ( https://pmjay.gov.in/)

As per the National Health Authority( 2022), the scheme through Health and Wellness Centres
(HWCs) envisions transforming Primary Health Centres (PHCs)/Sub-Centres (S.C.s) to provide
Comprehensive Primary Health Care (CPHC) with a focus on wellness and health promotion, with a
broader range of primary healthcare services, including access to medicines and diagnostics, to be delivered
close to the community. By November 30, 2022, 1,31,150 HWCs were functional against the targeted
1,50,000 HWCs by December 2022. HWCs are designed to provide Preventive, Prompt, Curative,
Rehabilitative, and Palliative care services and clinical management of common ailments by building a
strong referral system.