Approximately 514 million people across Bharat were covered under health insurance schemes in 2021, which merely covers 37% of the people in the country. Nearly 400 million individuals in Bharat have zero access to health insurance. Around 70% of the population is estimated to be covered under public health insurance or voluntarily private health insurance. The remaining 30% of the population –over 40 crore individuals, devoid of health insurance. Roughly 40–50% of Bharat’s population has health insurance coverage in 2025 — including government and private plans.

(These are approximate figures based on multiple recent estimates.)

Ayushman Bharat

Launched in 2018, Ayushman Bharat is a flagship program of the Government of Bharat, in line with the recommendations of the National Health Policy 2017 to realize the vision of Universal Health Coverage (UHC).  

Ayushman Bharat comprises two interrelated components:  

Ayushman Arogya Mandirs (formerly Health and Wellness Centres or AB-HWCs) and Pradhan Mantri Jan Arogya Yojana (PM-JAY). 

Ayushman Arogya Mandirs offer a wide range of healthcare services, including preventive, promotive, rehabilitative, and curative care.  

AB PM-JAY is the world’s largest publicly funded health assurance scheme, offering up to Rs 5 lakh per family per year for secondary and tertiary care hospitalization. There are about 55 crore beneficiaries of this scheme in the country. 12.37 crore families are getting benefits under the scheme. Under AB PM-JAY, there is no cap on family size, age, or gender, ensuring inclusivity for all beneficiaries. In addition, pre-existing diseases are covered from the very first day. In 2024, the Union Cabinet approved a major expansion of the AB PM-JAY to provide all senior citizens aged 70 and above with free health insurance coverage of up to Rs 5 lakh, regardless of income.  

Ayushman Bharat Digital Mission (ABDM):

Launched in 2021, the ABDM aims to create a digital health infrastructure for Bharat, enabling a seamless exchange of health data and enhancing accessibility, equity, and the quality of healthcare services. 

To enhance healthcare accessibility, existing Sub Health Centres (SHCs) and Primary Health Centres (PHCs), both rural and urban, are being upgraded to provide Comprehensive Primary Health Care (CPHC). 

Price controls in Bharat’s Health Sector

The National Pharmaceutical Pricing Authority (NPPA), an independent regulator for pricing of drugs in the Ministry of Chemicals and Fertilizers, enforces the price control and the availability of the medicines under National List of Essential Medicines (NLEM). In 2017, NPPA had fixed the ceiling price of knee implants to control the exorbitant trade margins under extraordinary circumstances.

A Delhi High Court judgement in 2021 directed NPPA to regulate the prices of certain medical devices. Following the court order, trade margins on oxygen concentrators, pulse oximeter, blood pressure monitoring machine, nebuliser, digital thermometer and glucometer were capped.

In February 2024 a parliamentary standing committee on Chemicals and Fertilizers had recommended that the devices which are required for critical care to the patients should be listed under NLEM.

The Supreme Court while responding to a PIL directed the Union Government to find a way to fix the price bands for all medical procedures and treatments offered by hospitals in the country and report back in 6 weeks failing which the Court indicated to impose the medical rates charged under the Central Government Health Scheme (CGHS) on all hospitals as an interim measure. (27, February, 2024). The Union Government did initiate consultations with states and hospital stakeholders after the Supreme Court’s February 2024 direction, but it has not yet notified a uniform, legally binding nationwide price band schedule for all medical procedures at private and public hospitals. The Supreme Court too has not applied CGHS rates as an interim nationwide ceiling across all private hospitals.

In 2011-12 The Ministry of Corporate Affairs advised The Institute of Cost Accountants of India (now known as Institute of Cost and Management Accountants of India or CMA) to arrive at a sample cost template, which can be used for arriving at cost of any two vital medical procedures. Accordingly, the CMA (India) prepared in 2015 “Guidance Note on Cost Management in Healthcare Sector”, detailing Costing Approach in Healthcare Sector, Costing Summary Template for Several Procedures and Hospital Management Information System.

It appears this initiative was not taken to its logical end subsequently. Now that the Supreme Court is insisting on price control for all medical procedures and treatments offered by hospitals, the government may revive the guidance note prepared by CMA (India) and get an updated version of the same and in line with that devise a set of guidelines for NPPA to enable the pharma sector regulator to enforce price control for major medical procedures and treatments (if not for all) offered by hospitals.

Moving towards Health for all

It is evident that all the initiatives mentioned above are at various stages of implementation. It is now time for scaling up these initiatives to take it to the next level, i.e., health for all. Health for all was defined by Halfdan Mahler, Director General (1973–1983) of the WHO in 1981as, “Health For All means that health is to be brought within reach of everyone in a given country. And by health is meant a personal state of wellbeing, not just the availability of health services – a state of health that enables a person to lead a socially and economically productive life. Health For All implies the removal of the obstacles to health – that is to say, the elimination of malnutrition, ignorance, contaminated drinking water and unhygienic housing – quite as much as it does the solution of purely medical problems such as a lack of doctors, hospital beds, drugs and vaccines.” Health for all is possible only when every citizen is covered under health insurance. Incidentally, IRDAI announced the goal of insurance for all by 2047. 

Can Bharat provide health for all?

Though the intention behind the launching of Ayushman Bharat is to address the secondary and tertiary health care needs of the people there is a need to critically evaluate the outcomes of the various existing health schemes and bring all the schemes-viz., primary, secondary and tertiary health care schemes, under one umbrella. Also, all the states should be encouraged to join under this single umbrella so that every citizen of the country is covered under this comprehensive health insurance scheme (CHIS), (Currently only West Bengal is not implementing Ayushman Bharat. Delhi has recently started implementing this scheme and Odisha is expected to join shortly). Health insurance premium amount will substantially reduce when the total population of the country is covered under this CHIS. The centre in consultation with the states and the health insurance companies may design the modalities of fixing the amounts of premium and the medical cover for the total population of the country under this CHIS in a uniform manner. In turn, the governments may bear the burden of the total premium for the people below the poverty line (BPL) and decide the premium subsidy to be given to the people who are above BPL and middle class depending on certain income criteria.

The government may also incentivize upper middle class and rich people by a nominal part funding of the premium and make this health insurance cover as mandatory for all the citizens of the country. Employers in the private sector to be mandated to extend this CHIS to their employees. Government may extend premium subsidy to the employers in MSME sector.

Thrust on preventive care

This CHIS should subsume all other existing medial health insurance schemes in the country. Master health checkup to be made compulsory at stipulated intervals for the renewal of this mandatory CHIS based on age criteria. Such a provision will result in early diagnosis of diseases and reduction in the incidence of curative health treatment which is also very expensive. Under this CHIS people may be given the option of selecting the hospital of their choice (i.e., government or private hospital) as well as the type of treatment (i.e, allopathy or alternative medical treatment) and cashless medical treatment to be encouraged which will give a boost to digital/ cashless payments culture in health care sector. All the states should have a state health regulatory authority which in turn will be under the overall supervision and guidance of an apex health regulatory authority at the centre.

An integrated citizens’ medical history data base to be developed in a highly secured web portal giving access to the doctors, hospitals, diagnostic centres and pharmacies in digital format.

Using tools like big data and analytics the government can take prompt proactive measures to improve the quality of health care services by effective monitoring of this web portal. Appropriate legislative measures are needed to protect the right to privacy of the people with regard to their health records and at the same time ensure freedom to the government to use this web portal for macro level policy making and take the required steps in preventive healthcare.

₹5 lakh crore is total healthcare budget allocation across all States & UTs and the Union Government’s allocation is Rs.90,000 Crore in FY 2024-25. This includes medical & public health expenditures such as hospitals, health programmes, insurance schemes, staff, etc. While the financial burden to the government may increase under this proposed CHIS, by scaling up the health insurance scheme to cover the total population of the country there will be significant reduction in the health insurance premium per head. The incidence of expensive curative health care can be reduced substantially since there will be greater focus on preventive health care by making master health check-up mandatory under this CHIS as mentioned earlier. 

Broad roadmap for Health for all mission  

Under the guidance of Niti Aayog both the Union Government and the States should discuss and arrive at a broad consensus to move forward towards “ Health for all” and a committee consisting of the representatives from States, Union Government and domain experts may be formed to recommend the modalities after studying the health care models in the countries like- U.K. Canada and Germany to know and adopt the global best practices in our healthcare.

The author suggests the following policy measures in this regard to achieve the Health for all mission in a time bound manner.

1. Setting up one medical college in every district in the country. Providing subsidized / free medical education to the students from rural areas with a caveat to serve in the villages after becoming doctors. 
2. Encourage PPP Models in rural healthcare by collaboration between the government, private hospitals and health insurance companies. 
3. Ensure every citizen of the country is covered under health insurance through appropriate legislative measures. 
4. Make master health checkup mandatory for renewal of health insurance cover at stipulated intervals based on age criteria in order to focus more on preventive health care and thereby reduce the burden of disease on curative healthcare. 
5. Creation and maintenance of master health records (i.e., Electronic Medical Records) of all the citizens on real time basis after taking necessary legislative measures that the right to privacy of the people is duly maintained.  
6. Government expenditure on healthcare to primarily focus on the following activities- providing the health infrastructure and supporting the initiatives of the private sector in providing health infrastructure, funding the health insurance premium burden of the poor and deserving people. 
7. All government hospitals to charge the patients for the health services who in turn will shift this burden to health insurance companies as they are covered under health insurance. 
8. Bringing health sector under the concurrent list of the constitution (currently it is under the state list) so that both the centre and the states could enhance their budgetary allocation under the health sector. 
9. Abolish all the health schemes (both centre and states) and instead the governments to spend those funds only for the health insurance premium of the people by either fully funding or part funding of the annual health premium depending on standard guidelines.  
10. To bring under NPPA various health interventions, including diagnostics and medical treatment (both surgical and non-surgical) along with medicines for price control in due course and NPPA may be renamed as National Health Care Pricing Authority.
11. In due course of time to provide free health insurance cover to all the citizens above 60 years of age. 

Reference:

1. https://www.forbes.com/advisor/in/health-insurance/health-insurance-statistics/.
2. Need for a Paradigm Shift in India’s Health Care, by Dr. B.N.V. Parthasarathi, published in ASCI Journal of Management (Vol.48, No.2 (SPL), September, 2019. ISSN No.0257-8069.