INDIA EXPLORES UNIFIED HEALTH SECTOR REGULATOR FOR INSURANCE

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TAG: GS 2: GOVERNANCE

THE CONTEXT: The Central government is considering the establishment of a health sector regulator to streamline and oversee both private and government health insurance schemes.

EXPLANATION:

• This move aims to enhance access to affordable insurance coverage for all citizens.
• The Ministries of Finance and Health are engaging in preliminary discussions regarding the necessity and potential implementation of such a regulatory body.

Need for a Unified Regulator

• Several doctors’ associations advocate for the consolidation of private and government insurance schemes under a single regulator.
• This initiative intends to regulate prominent government schemes such as Pradhan Mantri Jan Arogya Yojana, the Central Government Health Scheme, Employees’ State Insurance Corporation, etc.

Addressing Healthcare Accessibility

• Director-General of the Association of Healthcare Providers India (AHPI) emphasizes the necessity of restructuring government insurance schemes.
• The objective is to encourage more tertiary care hospitals to participate in these schemes, thereby enabling beneficiaries to access quality healthcare services.

Objective of ‘Insurance for All by 2047’

• Aligned with the IRDAI Vision 2047, the government’s ambition is to achieve ‘Insurance for All by 2047.’
• This comprehensive goal entails ensuring suitable life, health, and property insurance coverage for every citizen, accompanied by appropriate insurance solutions for enterprises.

Role of the Proposed Regulator

• Advocates have been advocating for an independent regulatory agency responsible for restructuring existing insurance schemes.
• The agency would be tasked with setting scientifically based reimbursement rates for various medical procedures.
• This effort aims to incentivize more hospitals to participate in these schemes, enabling expanded access to tertiary care services for beneficiaries.

Impact and Challenges

• Without the restructuring and regulation of reimbursement rates, many hospitals might hesitate to join government insurance schemes.
• This hesitation could potentially restrict beneficiaries’ access to crucial tertiary care services.
• Therefore, the proposed regulator is anticipated to address these challenges and ensure a more inclusive and efficient healthcare system.

Conclusion

• The establishment of a health sector regulator represents a significant step towards harmonizing and regulating insurance schemes in India.
• By unifying oversight under a single authority, the aim is to enhance accessibility, affordability, and inclusivity in healthcare services, particularly in providing tertiary care to a larger portion of the population.

SOURCE: https://www.thehindu.com/news/national/centre-exploring-one-stop-health-sector-regulator/article67666460.ece/amp/