The encyclopedia · Strategy & Leadership · Strategic decision · 2018
India insured 500 million by renting private hospitals
India's Ayushman Bharat insured 500 million poor people by giving them portable insurance to use existing private hospitals instead of building new ones.
Government of India
the move
By 2018, the Indian government estimated that more than six crore (60 million) people fell into poverty every year because of out-of-pocket hospital costs — a healthcare system that relied heavily on direct patient payment, with public hospital capacity far short of what a population of over a billion needed for secondary and tertiary care. The obvious path to universal coverage in most health systems is to expand public hospital infrastructure until it can serve everyone, a process that typically takes decades of sustained capital investment.
Rather than commit to building that infrastructure from scratch, the government announced Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) in India's February 2018 budget, and launched it on September 23, 2018, in Ranchi, Jharkhand, targeting coverage for roughly 10 crore households — about 50 crore (500 million) people, the poorest 40% of the country.
why it works
- Building hospitals takes decades, but private capacity already exists.
- Portable insurance lets patients choose any empaneled hospital, scaling coverage fast.
- State became payer, not builder, so coverage grew as fast as contracts were signed.
what transfers
When building capacity takes too long, buy access to existing capacity through portable entitlements and payment mechanisms.
what came after
By the 2020s the scheme had funded 116.9 million hospital admissions across 24,000+ empaneled public and private hospitals. Ayushman Bharat became the world's largest government-funded health assurance program by population covered, and its portable insurance-plus-private-empanelment model is studied internationally as an alternative to capital-intensive public hospital expansion for countries seeking to extend healthcare access quickly.
references
- Ayushman Bharat
- The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) after four years of implementation
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