‘Health Insurance for India’s Missing Middle’


On 29th October 2021, NITI Aayog released a comprehensive report titled Health Insurance for India’s Missing Middle, which brings out the gaps in the health insurance coverage across the Indian population and offers solutions to address the situation.

  • 50%: The Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana—a flagship scheme towards Universal Health Coverage, and State Government extension schemes—provides comprehensive hospitalization cover to the bottom 50% of the population.
  • 20%: Around 20% of the population is covered through social health insurance, and private voluntary health insurance primarily designed for high-income groups.

The ‘Missing Middle’

  • 30%: The remaining 30% of the population, devoid of health insurance, is termed as the “missing middle”.
  • The missing middle contains multiple groups across all expenditure quintiles and is spread across both urban and rural areas.

What the report Suggests

  • The report highlights the need for designing a low-cost comprehensive health insurance product for the missing middle.
  • It primarily recognizes the policy issue of low financial protection for health for the missing middle segment and highlights health insurance as a potential pathway in addressing that.
  • In doing so, the report offers a starting point for broader discussions on solutions, and specific products, to improve insurance coverage for the missing middle.
  • The report proposes wider industry and government stakeholder consultations, and discussion with consumer groups to delve deeper into the specifics of the problem, and potential solutions.