India’s Missing Middle: A Critical Analysis Of Health Insurance Coverage Disparities And Challenges

Tridibesh Dasgupta, LLM, School of Law, Christ University

ABSTRACT

Despite efforts to achieve Universal Health Coverage (UHC) by 2030, significant disparities persist in access to healthcare, particularly for those who fall between government-subsidized schemes and private health insurance. This group termed the "missing middle," lacks adequate financial protection for medical emergencies due to affordability issues and limited coverage options. Challenges include high out-of-pocket expenses, insufficient public awareness, and barriers to accessibility, especially for those in the unorganized sector. The analysis evaluates existing healthcare infrastructure, including government-subsidized, social, and private health insurance schemes, highlighting their limitations in adequately covering the missing middle. Policy recommendations address these challenges, emphasizing the need for increased public funding, primary healthcare investment, and improved distribution systems. Additionally, proposals include expanding the coverage of programs like the Employee State Insurance Scheme (ESIS) to encompass formal and informal sector workers, updating databases, and empowering state governments to play a more active role in healthcare provision. Achieving universal health coverage in India requires a comprehensive strategy prioritising equitable healthcare access for all segments of society. By addressing the needs of the missing middle and strengthening healthcare infrastructure, India can move closer to realizing the vision of affordable and accessible healthcare for all its citizens.

Keywords: Universal Health Coverage (UHC), Missing Middle, Health Insurance, Out-of-pocket Expenses (OOPE), Public Health Initiatives, Employee State Insurance Scheme (ESIS), Healthcare Infrastructure