New Delhi: Only 25% of the beneficiaries eligible under the Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (PMJAY) have so far enrolled themselves under the scheme, according to a report by the Confederation of Indian Industry (CII) and Boston Consulting Group (BCG) on Thursday.

The report titled Health Insurance Vision 2025 also said 59% of households in India do not have any health insurance plan. The report said within less than 5 lakh segment, 74% people do not have any health insurance, highlighting that most policies don’t cover all expenses. For example, out-patient department (OPD) expenses, accounting for 45% of total healthcare expenses, are not covered by most insurance policies.

The firms conducted a survey with respondents covering widespread demographic segments across city tiers, income segments, etc. It revealed the key issues hindering adoption of health insurance in the country that included low health insurance awareness.

“An assessment of drop-off points along the health insurance purchase funnel clearly indicates limited awareness (45%) as the major bottleneck in driving the adoption of health insurance. In the low income segments, 66% of the respondents eligible under PMJAY haven’t enrolled themselves due to low awareness while in high-income segments, awareness is particularly low in tier 2 cities, with only 41% participants aware about health insurance,” the report said.

Health insurance penetration in tier 3 cities is even lower (20-25%). Low presence of insurer branches and weak presence of the dominant agency channel are some of the key factors contributing to the lower penetration. For example, the survey indicated that while 60% of the overall policies are sold through agents, this number drops to only 30% in tier 3 cities, the report said.

“On the Ayushman Bharat Front, we have been working on four areas; to create awareness among the beneficiaries, to ensure that the rates provided to the private sector are consistent with market rates, to ensure the payment to the hospitals is done in a time bound manner, and to ensure a quick turnaround time,” Dr, RS Sharma, chief executive officer, National Health Authority, the implementing authority of Ayushman Bharat said. 

“We should as a country proceed towards UHC. We should proceed towards ensuring every eligible Indian either through public, private or co-payments. Co-payments can be used to support the missing middle segment of the population,” he said.

Covid-19 has exposed the inadequacies of healthcare ecosystems globally and compelled all nations to rethink their healthcare systems. The report released at the 15th Health Insurance Summit – “Health Insurance 2025 – Covering a Billion Indians” highlighted that in 2018, the Indian government took a major leap towards universal health coverage by providing health insurance cover to the bottom 40% of the poor and vulnerable population.

Despite the commendable measures taken, only 35% of Indian lives (480 million) are covered by a health insurance policy today. An epidemiological shift in disease burden towards non-communicable diseases requiring prolonged and expensive treatment along with rising healthcare inflation, has increased healthcare costs in the country. These factors, coupled with low government spending (1% of GDP) and high out-of-pocket (OOP) (63% of total) spending, have resulted in almost 4% of the population being pushed into poverty every year, the report said.

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