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Focus: GS-II Social Justice


  • Two countries which lead in the COVID-19 cases tally in the world today, namely the United States (first) and India (third), are also the ones where the need for health-care reform post COVID-19 has been most keenly felt.
  • This is due to the lack of effective universal health coverage (UHC) in these countries, which has broadened concerns beyond the frontiers of an epidemic response into the larger domain of access, equity, and quality in health care.

Legacy implications and UHC

  1. Certain entrenched characteristics of these health systems that have accrued over decades tend to dictate the terms of further evolution and lead to a number of compromises.
  2. The long legacy itself comprises a path-dependent trajectory that precludes far-reaching health-care reform.

For example: The US Affordable Care Act (ACA) envisaged a number of overarching measures to expand health insurance and improve access; however, the foundational aspects of U.S. health care, such as a fragmented private insurance landscape and a love for expensive specialised care, could hardly be altered due to their entrenched nature.

India’s attempts

  • The government has looked poised to employ Ayushman Bharat–Pradhan Mantri Jan Arogya Yojana (AB-PM-JAY) health insurance as the tool for achieving UHC, and such calls have only grown stronger in the context of the COVID-19 pandemic.
  • Plans are reportedly under way to extend coverage to the non-poor population under AB-PM-JAY, which currently covers the bottom 40% of the population.
  • Taking the health insurance route to UHC driven by private players, rather than strengthening the public provisioning of health care, is reflective of the non-negotiability of private health care in India.
  • This could have several unwanted consequences, which merits attention.
  • Stark maldistribution of health-care facilities (almost two-thirds of corporate hospitals concentrated in major cities) and low budgetary appropriations for insurance could mean that universal insurance does not translate to universal access to services.

Regarding National Digital Health Mission (NDHM)

  • Integration and improved management of patient and health facility information are very welcome.
  • However, in the absence of robust ground-level documentation practices and its prerequisites, it would do little more than helping some private players and adding to administrative complexity and costs like the electronic health records did under the US ACA.

Other Concerns

  • Covering the remaining population under the AB-PM-JAY presents massive fiscal and design challenges.
  • Turning it into a contributory scheme based on premium collections would be a costly and daunting undertaking, given the huge informal sector and possible adverse selection problems.
  • Meeting requirements through general revenue financing would greatly strain the exchequer and looks very unlikely especially in the immediate aftermath of the pandemic.

Click Here to read more about National Digital Health Mission (NDHM)

-Source: The Hindu

December 2023