Case study:

In India, private health insurance and out-of-pocket payments have historically prevailed as health financing systems. Healthcare expenditure incurs billions of dollars a year and almost 70% of this is spent in the private sector. Less than 4% of the gross domestic product (GDP) is spent on healthcare, of which 1.4% is funded by the government.

India is a lower middle-income country with a population of over 1.35 billion people, and there is a ratio of approximately 1 physician to every 1,000 people. The scarcity of healthcare providers, combined with the fact that the majority of healthcare providers are located in urban areas, poses a significant challenge to healthcare access. India's population is burdened by various infectious diseases, such as tuberculosis, malaria, tetanus, and rabies, and is considered the diabetes capital of the world. Furthermore, there are still scores of people living without access to clean water and sanitation (Nirula, Naik & Gupta, 2019).

The Indian government aims to increase public healthcare expenditure to 2.5% of GDP by 2025 (Nirula, Naik & Gupta, 2019). To achieve this, India aims to launch the Ayushman Bharat Pradhan Mantri - Jan Arogya Yojana, or AB PM-JAY, a government health programme that includes the Nation Health Protection Scheme. This programme aims to provide free healthcare to nearly 500 million people and is expected to absorb the dominant scheme that provides healthcare to those below the poverty line, Rashtriya Swasthya Bima Yojana (RSBY), as well as many state insurance schemes.

While RSBY did increase hospital admissions, it did not seem to reduce out-of-pocket payments. This was mainly due to issues with enrolment, insufficient insurance cover, and a lack of coverage for outpatient costs. A large part of the population was directly enrolled in the programme and were therefore not made aware of their enrolment or the benefits they had access to (Sharma, 2018; Nirula, Naik & Gupta, 2019).

Question 2

Assess the potential success and feasibility of AB PM-JAY as a pathway towards universal health coverage. Craft your assessment by answering the following question:

What challenges might AB PM-JAY face in achieving universal health coverage?