Health insurance for the middle class: Will the government introduce affordable health insurance for the middle class?
The cost of expensive medical treatment has become a major concern for middle-class families today. A sudden hospitalization resulting in a bill running into lakhs of rupees can derail the budget of any middle-class family. Addressing this issue, a parliamentary committee has recommended promoting affordable and accessible health insurance coverage for the middle class. Additionally, significant suggestions have been made regarding treatment costs in private hospitals. The committee advocates for clear and fixed rates for treatment packages so that patients know the expected cost before commencing treatment.
**Affordable Health Insurance for the Middle Class**
The parliamentary committee has stated that affordable and accessible health insurance schemes—such as 'Aarogya Sanjeevani'—should be promoted for the middle class. According to the committee, a large segment of the middle class falls outside the ambit of government health schemes. Consequently, they are forced to bear heavy out-of-pocket expenses during illnesses or medical emergencies.
The committee has recommended expanding health insurance products that feature simple policy terms and can benefit a wider population.
**Fixed Treatment Rates in Private Hospitals**
The committee has also made a major recommendation regarding treatment costs in private hospitals. It has proposed the establishment of transparent and standardized treatment packages for all healthcare providers. The objective is to reduce treatment costs and curb arbitrary charges. Specifically, there is a call to eliminate billing models—such as those linked to room rents—that inflate the total cost of treatment.
**Periodic Revision of Ayushman Bharat Package Rates**
The parliamentary committee has also made recommendations concerning the package rates under the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY). These rates should be reviewed periodically to account for inflation and the rising costs of new medical technologies. The committee suggests creating a statutory framework for this purpose, which also takes into consideration the varying economic conditions across different regions. This ensures the continued participation of private hospitals in the scheme without compromising the quality of treatment.
According to the committee, over 11 crore hospital admission cases have been covered under AB-PMJAY so far. The scheme involves 38,038 government and private hospitals, and treatments worth ₹1.57 lakh crore have been approved.
**Rising Medical Costs**
The parliamentary committee has also expressed concern over the rising costs of private healthcare. According to the report, the average out-of-pocket expenditure for a single hospital admission is ₹34,064. Meanwhile, the rate of medical inflation is estimated at around 10–13% annually; this means treatment costs are rising every year, directly impacting the finances of ordinary families.
The committee also stated that the benefits of government health insurance schemes should not be eroded by medical inflation or the rising costs of medical technology.
**Recommendation to Simplify Cashless Claim Settlement**
To expedite health insurance claim settlements, the committee has recommended better utilization of the National Health Exchange platform. The aim is to make cashless claim settlement faster and more transparent. The committee also emphasized the strict implementation of recent insurance reforms, including the removal of the upper age limit for purchasing health insurance policies and capping the waiting period for pre-existing conditions at three years.
**Jan Aushadhi Kendras in Every Block, AMRIT Pharmacies in Hospitals**
To make affordable medicines accessible to more people, the committee has recommended opening Jan Aushadhi Kendras in all remaining block-level government health facilities. Additionally, it has advocated for promoting AMRIT pharmacies in large private hospitals, where patients can obtain medicines, implants, and surgical supplies at affordable prices.
**Affordable Dialysis Up to the Sub-District Level**
The committee has also put forward a significant proposal to reduce the cost of dialysis. The committee has stated that possibilities should be explored to extend free or low-cost hemodialysis facilities beyond district hospitals to the sub-district level; public-private partnerships could be utilized for this purpose. According to the committee, patients have saved an estimated ₹10,102 crore so far through the National Dialysis Programme.
**Advice to states to increase health budgets**
The committee has also urged states to increase the share of the health sector in their total budgets. It recommends that states spend at least 8% of their total expenditure on the health sector. The committee has further suggested that the central government should encourage states to do so.
**Recommendation to include AYUSH treatments in Ayushman Bharat**
The committee has recommended including AYUSH treatment packages under AB-PMJAY. It also emphasized ensuring that scheme beneficiaries do not incur any out-of-pocket expenses for the treatment. Additionally, guidelines have been proposed to integrate private healthcare providers with the Ayushman Bharat Digital Mission.
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