New Delhi, The government is actively considering doubling the beneficiary base of its flagship Ayushman Bharat health insurance scheme over the next three years, including everyone above 70 years of age under its ambit to begin with, and also increasing insurance coverage to 10 lakh rupees per year.
The proposals, if approved, would entail an additional expenditure of Rs 12,076 crore per year to the exchequer, according to estimates prepared by the National Health Authority, official sources said.
"The possibility of doubling the AB-PMJAY beneficiary base in the next three years is being discussed, which, if implemented, will cover more than two-thirds of the country's population with health coverage," sources said, noting that Medical expenses are one of the main reasons that push families into debt.
"Deliberations are also underway to finalize a proposal to double the cover amount limit from the current Rs 5 lakh to Rs 10 lakh," they said.
These proposals or parts of them are expected to be announced in the Union Budget to be presented later this month.
In the interim budget 2024, the government increased the allocation for Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), which provides health cover of Rs 5 lakh per family per year for secondary and tertiary care hospitalization to 12 million families , for Rs 7,200 crore, while Rs 646 crore was allocated for the Ayushman Bharat Health Infrastructure Mission (PM-ABHIM).
President Droupadi Murmu, addressing the joint session of Parliament on June 27, said that all senior citizens above 70 years of age will also be covered and get the benefit of free treatment now under the Ayushman Bharat Yojana.
Those above 70 years of age add up to 4-5 crore more beneficiaries covered under the scheme, another source said.
The Rs 5 lakh limit for AB-PMJAY was fixed in 2018. Doubling the coverage amount is aimed at tackling inflation and providing relief to families in case of high-cost treatments like transplants, cancer, etc.
The NITI Aayog, in its report titled 'Health Insurance for India's Lost Middle' published in October 2021, suggested expanding the scheme. It was claimed that around 30 per cent of the population lacks health insurance, highlighting the gaps in health insurance coverage across the Indian population.
The AB-PMJAY flagship plan towards Universal Health Coverage and the state government's extension plans provide comprehensive hospitalization coverage to the bottom 50 per cent of the population.
About 20 percent of the population is covered by social health insurance and voluntary private health insurance designed primarily for high-income groups.
The remaining 30 percent of the population lacks health insurance; The actual uncovered population is higher due to the existing coverage gaps in the PMJAY and the overlap between plans. This discovered population is called the missing middle, according to the report.
The missing middle ground is not a monolith: it contains multiple groups across all spending quintiles. The missing middle sector predominantly constitutes the informal sector of the self-employed (agricultural and non-agricultural) in rural areas, and a wide range of occupations (informal, semi-formal and formal) in urban areas, according to the report.
The report highlighted the need to design a low-cost comprehensive health insurance product for the missing middle.
It mainly recognizes the political problem of low financial health protection for the missing middle segment and highlights health insurance as a potential avenue to address it.
The proposals, if approved, would entail an additional expenditure of Rs 12,076 crore per year to the exchequer, according to estimates prepared by the National Health Authority, official sources said.
"The possibility of doubling the AB-PMJAY beneficiary base in the next three years is being discussed, which, if implemented, will cover more than two-thirds of the country's population with health coverage," sources said, noting that Medical expenses are one of the main reasons that push families into debt.
"Deliberations are also underway to finalize a proposal to double the cover amount limit from the current Rs 5 lakh to Rs 10 lakh," they said.
These proposals or parts of them are expected to be announced in the Union Budget to be presented later this month.
In the interim budget 2024, the government increased the allocation for Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), which provides health cover of Rs 5 lakh per family per year for secondary and tertiary care hospitalization to 12 million families , for Rs 7,200 crore, while Rs 646 crore was allocated for the Ayushman Bharat Health Infrastructure Mission (PM-ABHIM).
President Droupadi Murmu, addressing the joint session of Parliament on June 27, said that all senior citizens above 70 years of age will also be covered and get the benefit of free treatment now under the Ayushman Bharat Yojana.
Those above 70 years of age add up to 4-5 crore more beneficiaries covered under the scheme, another source said.
The Rs 5 lakh limit for AB-PMJAY was fixed in 2018. Doubling the coverage amount is aimed at tackling inflation and providing relief to families in case of high-cost treatments like transplants, cancer, etc.
The NITI Aayog, in its report titled 'Health Insurance for India's Lost Middle' published in October 2021, suggested expanding the scheme. It was claimed that around 30 per cent of the population lacks health insurance, highlighting the gaps in health insurance coverage across the Indian population.
The AB-PMJAY flagship plan towards Universal Health Coverage and the state government's extension plans provide comprehensive hospitalization coverage to the bottom 50 per cent of the population.
About 20 percent of the population is covered by social health insurance and voluntary private health insurance designed primarily for high-income groups.
The remaining 30 percent of the population lacks health insurance; The actual uncovered population is higher due to the existing coverage gaps in the PMJAY and the overlap between plans. This discovered population is called the missing middle, according to the report.
The missing middle ground is not a monolith: it contains multiple groups across all spending quintiles. The missing middle sector predominantly constitutes the informal sector of the self-employed (agricultural and non-agricultural) in rural areas, and a wide range of occupations (informal, semi-formal and formal) in urban areas, according to the report.
The report highlighted the need to design a low-cost comprehensive health insurance product for the missing middle.
It mainly recognizes the political problem of low financial health protection for the missing middle segment and highlights health insurance as a potential avenue to address it.
