Realistic universal health coverage

The insurance regulator's move to set up an expert panel to draw a road map for universal health coverage is a good idea. This would entail extending financial protection for health to the missing middle - about 30% of the population, or 40 crore people - who are not covered by any of the government's national insurance schemes, or private insurance or employer's group health cover. The panel's mandate includes recommending a universal standard health product that is simple. A 2021 NITI Aayog report had suggested improvements to the existing Arogya Sanjeevani plan to this effect. But insurers would want to underwrite health policies only if they are realistically priced.

Group enrolment will help the creation of a large diversified risk pool. Lowering the operational cost for insurers can bring the premiums close to actuarially determined prices. The cost would also depend on the quality of health infrastructure, competition and governance in states. Hugely raising public spending on health, and strengthening public facilities at all levels, bolster GoI's bargaining position to prudently buy services from the private sector.

Leveraging capacities from the private sector for tertiary care, deploying digital platforms, technology and data, processes and experiences from PMJAY and the Employees State Insurance Scheme are in order. Shifting steadily to accountable healthcare, instead of a purely insurance-driven model makes sense. Hospitals can be paid a per capita amount upfront to keep people healthy and treat them if they fall ill. Actuarial expertise can be used to estimate the per capita amount the provider has to be paid. As care providers must ensure quality outcomes, there will be no incentive on their part to inflate costs.