India’s national health insurance scheme: Analysis using the Growth Diagnostics Framework

Abstract

Abstract The world's largest health assurance scheme, Ayushman Bharat-Pradhan Mantri Jan Suraksha Yojana (AB-PMJAY) was launched in India in 2018 to achieve universal health coverage aspired in the National Health Policy 2017. Our objective was to critically analyse AB-PMJAY through the lens of Growth Diagnostics Framework developed by Hausmann, Rodnik et al using secondary data. The framework analysed the scheme on five aspects: physical investment, knowledge/application/productivity, productive livelihood, skill set and cooperative federalism in terms of demand and supply side problems. The analysis was conducted for six months. The results highlighted issues relating to supply side such as availability of beds, equipment, manpower, information systems, deficient rural public health facilities, health insurance governance, scaling technological capabilities, improving procurement of drugs, equipment, technical training of staff in IT; highly skewered ratio of public and private sector hospital beds and manpower. Demand side issues include high demand of services, requirement of research and development related to premium rates, maturity of the scheme, pay outs, increased demand of specialists/technicians/health administrators in government sector and willingness of federal states to enroll in the scheme. Our recommendations highlight the importance of gaining the trust and confidence of citizens in public sector, reducing asymmetric information, mandating a formulary policy in hospitals, measures to prevent private hospitals from indulging in cream skimming and dumping patients, increasing package amounts for chronic conditions like dialysis, more health technology assessments, strengthening referral levels of care, focusing on outcome based standards for facilities, creating demand for preventive and promotive care using innovative ICT tools and coordination with different systems of medicine, addressing social determinants of health through inter-sectoral convergence. Key messages Growth Diagnostics Framework is a novel way to study a national health insurance scheme. India's national health insurance scheme is dynamic and aspirational that requires multi sectoral co-ordination.