Work in Progress: On the Household Social Consumption (Health) Survey

📌 Summary:

• Context: NSS 80th Round Household Social Consumption (Health) Survey is the first comprehensive health survey post-pandemic and after PMJAY matured
• Key finding: Insurance coverage expanded ~3x since PMJAY's launch in 2018; now accounts for increasing share of hospital financing
• BUT hospitalisation rate has NOT recovered to 2014 levels — having insurance card does not guarantee bed access; hidden costs persist
• Private hospitals: PMJAY/state-scheme reimbursement rates below market rates → hospitals bill patients separately for diagnostics and ancillary services → effective out-of-pocket costs rise despite insurance
• Out-of-pocket (OOP) spending: Fell for inpatient hospitalisation (insurance absorbing costs) but ROSE for outpatient interactions like surgeries and chronic care
• Contradictory trends: (a) Health care becoming more affordable for primary/secondary care (public sector absorbing costs); (b) Catastrophic costs remain high for tertiary care (private sector dominates)
• Structural problem: AAM (Ayushman Bharat Arogya Mandirs) network significantly underfunded for chronic disease management
• Net result: Poor have nominal coverage but often excluded from practical benefits; insured middle class faces rising catastrophic costs
• Solutions proposed: Strengthen public sector hospital capacity for tertiary care; reform PMJAY reimbursement rates; better fund AAM network

📌 Prelims Facts:

• PMJAY = Pradhan Mantri Jan Arogya Yojana; launched Sept 2018; covers up to Rs 5 lakh/year for secondary and tertiary hospitalisation
• NSS = National Sample Survey (by National Statistical Office); 80th round = latest health round
• AAM = Ayushman Bharat Arogya Mandirs (transformed sub-health centres/PHCs for primary care)
• AB-PMJAY is the world's largest government-funded health insurance scheme