Analysis of the Rise and Risks of Health Insurance Schemes in India
State-sponsored health insurance schemes like Pradhan Mantri Jan Arogya Yojana (PMJAY) and State Health Insurance Programmes (SHIPs) have expanded significantly, yet challenges to Universal Health Care (UHC) persist. These schemes are often restricted to in-patient care and rely heavily on private providers, which can lead to profit-driven motives and exclusion of the poor. Issues include low utilization rates due to lack of awareness, discrimination against insured patients by private hospitals, and delayed reimbursements. Experts argue that insurance is not a substitute for direct public investment in primary healthcare infrastructure.
Key Points
- PMJAY and SHIPs are modeled with a maximum cover of ₹5 lakh per household annually, but are mostly restricted to in-patient care.
- Public expenditure on health in India remains low at 1.3% of GDP, compared to a world average of 6.1%.
- Private hospitals often prefer uninsured patients due to higher commercial charges compared to insurance reimbursement rates.
- The National Health Authority (NHA) recently revealed pending dues under PMJAY totaling over ₹12,161 crore.
Exam Facts
- Pradhan Mantri Jan Arogya Yojana (PMJAY) launched in 2018
- India's public health expenditure: 1.3% of GDP
- World average health expenditure: 6.1% of GDP
- Bhore Committee report of 1946
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