Editorial: India needs to strengthen public sector hospital capacity and address healthcare financing gaps
The 80th round of the National Statistical Office's health survey reveals expanded insurance coverage, largely due to PMJAY, but hospitalisation rates haven't recovered to 2014 levels, indicating access barriers and hidden costs persist. While public sector absorption of primary and secondary care costs has made healthcare more affordable, catastrophic costs remain high in some cases. The editorial highlights that PMJAY reimbursement rates are often below market rates, leading private hospitals to charge extra for diagnostics. The next phase of healthcare reform must focus on strengthening public sector hospital capacity to compete with the private sector for tertiary care and ensure universal access.
Key Points
- Insurance coverage has expanded threefold since PMJAY's launch, but hospitalisation rates remain below 2014 levels.
- Hidden costs and below-market reimbursement rates for PMJAY lead to private hospitals charging patients extra.
- The public sector has made primary and secondary care more affordable, yet catastrophic costs for some remain high.
- The AAM network, providing free medicines and diagnostics, is underfunded, and the private sector dominates chronic disease management.
- Future healthcare reforms should prioritize strengthening public sector hospital capacity to improve access and affordability.
Exam Facts
- Survey: 80th round of household social consumption (health) survey by National Statistical Office.
- Scheme: Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY), launched in 2018.
- Median Out-of-Pocket Expenses (OOPE) per hospitalisation: ₹11,285.
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