India and the ‘managed care’ promise

Last Updated01/06/2024

Health insurance as the main modality of universal health coverage (UHC) now looks to be ingrained in Indian health policy thinking.
Combining insurance and health-care provision under one roof can be called the Indian iteration of a managed care organisation (MCO).
It is timely to reflect on whether MCOs hold promise for the bigger Indian health-care landscape, particularly when it comes to extending universal health care.

Ever since then, MCOs have evolved into multiple generations and forms, and have penetrated deep and wide into the health insurance space.
- Evidence indicates that they did help in reducing costly hospitalisations and associated costs.
- In India, ever since the first public commercial health insurance was promulgated in the 1980s.
In an early analysis of how the HMO or health maintenance organisation, a type of MCO) experience panned out for developing nations
- MCOs tended to be urban-predominant, attracting the high-income cohort.

In 2021, NITI Aayog released a report endorsing an care insurance scheme based on a subscription model,
- which would generate savings through better integration of care.
Under the Ayushman Bharat Mission, incentives were announced for opening of hospitals in underserved areas which would cater to beneficiaries of the Pradhan Mantri Jan Arogya Yojana (PMJAY).
- Similar incentives could be conceived for MCOs, which would insure and cater to PMJAY patients apart from a private, self-paying clientele on a pilot basis.
The same applies to other public sector social health insurance schemes.
- This would also contribute to increasing awareness and expanding the reach of MCOs over time, as the self-paying pool expands and grows the demand base.
Universal Health Coverage is a complex maze, and as in all complex systems, there is never a solitary answer to a complex question.
While MCOs cannot be expected to be the perfect solution, they can be part of the bigger answer that Indian health care seeks today.