Missing Middle: Over 90 Crore Indians Lack Social Financial Health Protection Schemes

Indore, Madhya Pradesh - Indian Medical Association (IMA) national president Dr RV Asokan has highlighted the dismal state of healthcare protection in India, revealing that more than 90 crore people lack social financial health protection schemes due to coverage gaps. This 'uncovered' population is terming as the missing middle, where only 25% of people are covered by theAyushman Bharat scheme, while 10% can afford their own care.

Addressing the glaring healthcare inequities, Dr Asokan emphasized that the government's push towards private health insurance and imposition of an 18% GST for acquiring such insurance is unfair. He stressed the need for a tax-funded universal healthcare system to provide access to healthcare for this substantial section of people.

Outpatient care, accounting for 63% of the total healthcare expenditure in India, is neither covered under Ayushman Bharat nor private medical insurance, leaving no avenue for reducing catastrophic healthcare expenditures. Dr Asokan highlighted that public investment has shifted towards hospital ownership by the private sector and profitable hospitals which increase existing challenges facing the entire sector.

"The government should reconsider its approach to address pressing issues," said Dr Asokan. "It is essential to alter the direction through policy, not just focus on increasing medical college admissions. Increasing investments in healthcare will be necessary, especially addressing hospital bed capacity."

There are 706 medical colleges in India producing approximately 1 lakh doctors annually, yielding a doctor-to-population ratio of 1:811. However, insufficient investment in healthcare infrastructure and an insatiable focus on private sector growth for more doctors seems uncalled for.

The issue also includes the alarming lack of financial commitment to healthcare as a non-priority sector – with only between 1.1% and 1.3% of GDP spent on it compared to 5% in neighboring countries such as Bangladesh.