Ayushman Bharat (AB-PMJAY) and Primary Health Care (PHC) Neglect
Focus on Tertiary Care: AB-PMJAY primarily focuses on hospitalizations, surgeries, and tertiary care, neglecting the fundamental principle of PHC.
Shift from Preventive Care: The insurance-based model diverts resources away from preventive and community-based health care, leading to increased long-term costs.
It strengthens market-driven private health care while potentially weakening the public health infrastructure.
While aiming to reduce out-of-pocket expenditure (OOPE), it's unclear how much it benefits marginalized groups and supports PHC to lower overall costs.
Contradiction to Bhore Committee’s vision of strong primary health care, with a pyramid-shaped health system tapering to secondary and tertiary care
Budgetary Allocations and Privatization
The health budget prioritizes medical digital infrastructure and medical education expansion over PHC.
The National Health Mission (NHM), crucial for grassroots healthcare, receives a declining share, indicating a shift towards privatization.
Increased funding for AB-PMJAY further promotes privatization and insurance-based financing.
Raising the FDI cap in the insurance sector aims to attract more private players, but raises concerns about accessibility for vulnerable populations.
Challenges for Vulnerable Populations and Data Issues
Policy changes raise concerns for India’s large informal workforce, which lacks universal health coverage.
Insurance illiteracy and reliance on middlemen complicate access for migrant and non-literate working classes.
Without private sector regulation, OOPE may increase due to inflated medical costs.
Data Limitations: Outdated census and labor force survey data hinder efficient allocation and utilization of social protection schemes.
Coverage of ASHA workers is uncertain.
Global Lessons and Recommendations
The U.S. experience warns against over-reliance on private insurance, leading to high costs and inequality.
India can learn from countries like Thailand and Costa Rica, which prioritize tax-funded universal coverage and strong public health investments.
India should invest in preventive, community-based care accessible to all, rather than disproportionately favoring private tertiary care.
Implement comprehensive public health benefit packages, cost-control mechanisms, and programs to reduce OOPE.
Implement safeguards to prevent private insurance from driving up healthcare costs.
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