Work in progress: On the Household social consumption (health) survey

📌 Summary:

• Context: NSO's 80th round Household Social Consumption (Health) Survey — first comprehensive survey post-pandemic AND post-PMJAY maturity; assesses impact of Ayushman Bharat PMJAY launched in 2018

• PMJAY Progress: Insurance coverage has expanded ~threefold since 2018; now accounts for an increasing share of healthcare financing in hospitals

• Core Argument: Nominal insurance coverage hasn't translated into real access or financial protection — structural gaps in public health capacity and reimbursement mechanisms remain

• Causal Chain (access gap): PMJAY/State insurance reimbursement rates are below market rates → private hospitals compensate by billing patients separately for diagnostics and ancillary services → effective out-of-pocket costs remain high despite having an insurance card → hospitalisation rate has NOT recovered to 2014 levels

• Causal Chain (catastrophic costs): Public sector absorbs primary/secondary care costs → healthcare more affordable at lower levels → BUT chronic care and surgeries dominated by private sector → middle class with insurance faces rising catastrophic expenditure for tertiary care

• AAM Network gap: Free medicines and diagnostics network under Ayushman Bharat significantly underfunded relative to chronic disease management needs

• Key Data: 80th NSO round; insurance coverage tripled since PMJAY 2018; hospitalisation rate below 2014 level

• Equity issue: Poor have nominal coverage but often excluded from actual benefits in practice; more insured middle class faces rising catastrophic costs

• India's Vulnerability: Dominance of private sector in tertiary care means public insurance schemes can't fully protect against high-cost care

• Solutions Proposed: Strengthen public sector hospital capacity to compete with private sector for tertiary care; increase AAM network funding for chronic diseases; improve PMJAY reimbursement rates to reduce hidden billing