Relevance: GS-2: Issues Relating to Development and Management of Social Sector/Services relating to Health, Education, Human Resources.

Key Phrases: National Health Authority (NHA), CoWIN platform, Universal immunization program, Vaccination, Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), Missing Middle, Insurance penetration in India.

Why in News?

• The National Health Authority (NHA) plans to use the CoWIN platform for the universal immunization program for vaccinating children and pregnant women against preventable diseases.
• Given that only 10,000 private hospitals are part of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), the government’s focus is to increase their participation under the Centre’s flagship health scheme.

How CoWIN platform turned out to be a Succes story?

• The CoWIN platform has been able to scale rapidly with the increasing pace of vaccination.
• With a phased rollout of the vaccination program, the CoWIN platform has scaled quickly in an agile manner.
• This is evident from the platform’s multi-fold scale-up from 2-3 million vaccinations daily during phases 1 and 2 to a global high of 25 million vaccinations in a day during phase 3.
• There were multiple private and government applications (Umang, Arogya Setu), which have integrated with APIs of CoWIN and provided vaccination registration services.
• CoWIN is a powerful example of how digital technology can expand public health programs and reflects the strides India continues to make in digital technology for public services.

What provisions are being made in CoWIN for the vaccination of children and adolescents?

• From January, the policy for vaccination administration enabled the inclusion of the adolescent population. Initially, it was for the age groups 15-17, followed by age groups of 12-14.
• For those belonging to the 12-17 age group, Covaxin, Corbevax and Covovax have been approved and digitally-enabled for seamless registrations and recording through CoWIN.
• Additionally, six members can be registered on one mobile number, allowing parents to add their children to their registered CoWIN accounts.
• Furthermore, discussions are on to repurpose CoWIN platform to accommodate the universal immunization program for providing vaccination to children and pregnant mothers against preventable diseases.

Why have other countries shown interest in adopting this technology?

• India decided to adopt a completely digital approach while planning its vaccination strategy.
• This helped people prove that they have been vaccinated, easing the renewal of socio-economic activities in a phased manner.
• A safe, secure, and trustworthy proof helped people establish when, where, and by whom they have been vaccinated.
• The digital approach also helped track the usage of vaccination and minimize wastage.
• India is providing the CoWIN platform free of cost to nations interested in adopting and customizing it.
• Over 140 countries attended the CoWIN Global Conclave to learn about this technology.
• After the conclave, nearly a dozen countries expressed interest in exchanging learnings and best practices on digital administration of the covid vaccination program.

How does India plan to expand the benefits of AB-PMJAY?

• PMJAY is catering to a population of 107.4 million families included in the Socio-Economic Caste Census (SECC) 2011.
• The scheme has been implemented in 33 states and Union territories.
• States/UTs, in alliance with state health insurance schemes, have further extended the beneficiary base to 145 million families.
• Since 2021, the AB-PMJAY platform is being used to extend healthcare benefits to other categories of beneficiaries.
• The Employees’ State Insurance Scheme is now operational through the AB-PMJAY platform (IT system, hospital network) in 157 districts.
• Benefits under AB-PMJAY have also been extended to building and construction workers in Bihar, Chandigarh, Nagaland, and Uttar Pradesh.
• Discussions are going on with nodal ministries to cover vulnerable sections like manual scavengers and transgender people.
• With AB-PMJAY adopting a zero-tolerance approach towards fraud and abuse, 210 hospitals that engaged in unethical practices, including denial of treatment to the scheme beneficiaries, have been removed, while approximately 50,000 suspect transactions were cancelled.

India’s Health Insurance scenario:

• The Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) and State Government extension schemes, provide comprehensive hospitalization cover to the bottom 50% of the population – around 70 crore individuals.
• Around 20% of the population– 25 crore individuals –are covered through social health insurance, and private voluntary health insurance.
• The remaining 30% of the population is devoid of health insurance; the actual uncovered population is higher due to existing coverage gaps in PMJAY and overlap between schemes.

Who is ‘Missing Middle’?

• Financial distress due to hospitalization is not restricted to poor families alone.
• Any family not covered under a health insurance scheme will have to confront catastrophic health expenses.
• Unfortunately, many such “non-poor” families cannot afford the premiums chargeable for commercial health insurance policies.
• This section of society is referred to as ‘Missing Middle’ and comprises informal sector workers, self-employed, small business owners, etc.
• According to the NITI Ayog report at least 30% of the population, or 40 crore individuals – is called the missing middle.

How needs of ‘Missing Middle’ are being catered to?

• NHA is exploring options to extend healthcare protection to the “Missing Middle”.
• A pilot project is being launched wherein insurance providers can use the AB-PMJAY platform to cover different population groups.

Way forward:

• There is a need for designing a low-cost comprehensive health insurance product for the missing middle. The government and the private sector will need to come together in this endeavour.
• Private sector ingenuity and efficiency are required to reach the missing middle and offer compelling products.
• The government has an important role to play in increasing consumer awareness and confidence, modifying regulations for standardized product and consumer protection, and potentially offering a platform to improve operational efficiency.

Source: Live-Mint

Mains Question:

Q. Expansion of health insurance coverage is a necessary step and a pathway in India’s effort to achieve Universal Health Coverage (UHC). Critically analyse issues with India’s health insurance sector and measures needed to fix them.