The Ayushman Bharat programme provides the structure for translating such investment into concrete outcomes for the people. It includes Ayushman Arogya Mandirs for comprehensive primary health services — promotive, preventive, curative, palliative and rehabilitative care —without incurring any financial burden. It also features the Pradhan Mantri Jan Arogya Yojana (PMJAY) which uses the health insurance model to provide access to secondary and tertiary health care to nearly 50% of the population. These are ambitious policies that depend on an improved fiscal context and coordinated governance across the central and state governments. Directed investments towards strengthening institutional governance and capacities for regulation, quality control, enforcement, fraud control, grievance redressal and research have to be prioritised.
Even if all of this is achieved, current policies still leave out about 30% of our population from any coverage for secondary and tertiary care that is potentially high-impact and impoverishing. Addressing coverage for this missing middle is especially important as India seeks to achieve developed nation status.
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