Context: The lack of effective Universal Health Coverage (UHC) makes a health-care reform in India post COVID-19 indispensable.
Issues holding back Healthcare Reforms:
United States: Fragmented private insurance landscape and love for expensive specialized care limiting the expansion of health measures and improving access.
E.g. The US A?ordable Care Act (ACA) failed to alter the insurance landscape.
India: Maldistribution of healthcare facilities and low budgetary appropriations for insurance could not help translate into UHC
Ayushman Bharat–Pradhan Mantri Jan Arogya Yojana (ABPMJAY): a tool for achieving UHC heavily relies on the private sector.
Absence of regulatory robustness: in handling malpractices and monopolistic tendencies, has a major cost, equity, and quality implications.
For, E.g. a potent ‘Clinical Establishments Act’ is a must before embarking on a UHC involving largescale publicprivate collaboration.
National Digital Health Mission (NDHM): it will add administrative complexity and costs in the absence of regulations, robust ground-level documentation practices and its prerequisites.
Political Hindrances: Integrating fragmented schemes into a unified system, is challenged by sustained political consensus.
Path-dependent Trajectory of Long Legacy: resists the changes brought in through reforms.
In the United States: The ACA reforms superimposed on nonnegotiable elements, constrained the nature and scope of those reforms.
E.g. the ACA has been not very successful in ensuring access commensurate with insurance levels and checking the rise of premiums and outofpocket costs.
In India: The bigger and deeper the reform, the more is the resistance.
Turning the AB-PM-JAY into a contributory scheme based on premium collection would be a costly and daunting task, given the huge informal sector.
Harmonizing the benefits ad entitlements among the beneficiary groups and formalization of outpatient care remains a formidable challenge.
Ayushman Bharat–Pradhan Mantri Jan Arogya Yojana (AB-PM-JAY):
AB-PM-JAY is envisaged as a tool for achieving Universal Health Care (UHC).
It currently covers the bottom 40% of the population
It may extend coverage to the non-poor population
Way forward:
Robust regulatory and administrative architecture for the effective roll-out of UHC
Mobilize sufficient and sustained political consensus for integrating fragmented schemes into a unified system
Widespread public consensus and pressure for health-care reform by civil society
Invoking States with higher per-capita public spending on health to back the reform as they fared better against COVID-19.
Politics need to encourage health: having populist significance and marshal enough will to negotiate organized opposition to change.