Recently, the Central Government has extended the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) to provide health cover for senior citizens above the age of 70. It is a significant step towards universalising healthcare in the country. The Rs 5 lakh annual health coverage will benefit about six crore people, which translates to roughly 5 per cent of the country’s current population.
In this article, we will look into the status of elderly in India, the expansion of Ayushman Bharat Scheme to include elderlies, the significance of the inclusion. We will also look at the challenges that persist despite this laudable move.
What is the Status of Elderly Population in India? What are the Health care concerns of senior citizens in India?
The number of elderlies (persons above 60 years) in India is set to increase from 100 million in 2011 to 230 million in 2036. By 2050, the elderly population is expected to constitute nearly one-fifth of the total population.
Increase in the old age-dependence ratio-
The old age-dependence ratio denotes the number of persons aged 60-plus per 100 persons in the age group of 15-59 years.
According to the Ministry of Statistics and Programme Implementation’s (MOSPI) ‘Elderly in India 2021‘ report, the old-age dependency ratio is increasing in India. The old age-dependence ratio has increased from 10.9% in 1961 to 14.2% in 2011 and is projected to increase to 15.7% in 2021 and 20.1% in 2031 respectively.
Health care Concerns of Senior Citizens
1. Rise in age-related chronic illness- According to the Longitudinal Ageing Study of India (LASI) in 2021, One in five elderly persons in India has mental health issues and around 75 per cent of them suffer from a chronic disease.
2. Increasing need for geriatric care- Increased health-related expenses for the treatment of diseases like Non-Communicable diseases, cataract, hearing loss etc. creates financial problem for the elderly population.
What are the specifications of the expanded Health Cover for Senior Citizens?
AB PM-JAY- AB PM-JAY is already the world’s largest public health insurance scheme. It provides free cover upto Rs 5 lakh annually to all members of eligible families, which are estimated to comprise the bottom 40% of the population economically, irrespective of age.
Health Cover Extension under AB PM-JAY- The Health cover for Senior Citizens has been expanded under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY). The expanded scheme will cover almost 6 crore individuals (from 4.5 crore families), of whom 1.78 crore are already covered by the scheme.
| Beneficiaries | a. Anyone who has turned 70 as per their Aadhaar can register for the new health cover. b. Everyone of age 70 or more will be entitled to a cover of Rs 5 lakh annually, shared within the family. This means if there are two elderly beneficiaries in the household, the cover will be split among them. c. Elderly members (age 70 and more) of families that are already covered in accordance with their economic status will get a top-up cover of Rs 5 lakh– to be used only for the elderly. These elderly beneficiaries will have to re-register to receive the top-up cover. |
| Registration | a. Beneficiaries can register either through the government’s Ayushman App or at the Ayushman Bharat counter at any government health facility. b. Beneficiaries will be able to utilise their policy as soon as they complete their eKYC. The portal will also be face-authorisation-enabled, to ensure that even elderly persons whose fingerprints are difficult to read or have changed over time can avail the benefits. |
| Exclusions and Inclusions | a. Option for already covered people- 80 lakh people are separately covered under various government health schemes- the Central Government Health Scheme (CGHS), Ex-Servicemen Contributory Health Scheme, or cover provided to family members of defence and railway personnel. Those who are covered under these government health schemes will have the option of choosing either Ayushman Bharat or continuing with their existing coverage. b. People with ESIC coverage to be included- People who are covered under the Employees State Insurance Corporation (ESIC), however, will be eligible to have both their existing cover and Ayushman Bharat. This is because premiums for ESIC are paid by the insured and their employer, not the government. c. People with private insurance- People who have their own privately purchased insurance cover will be eligible to have the Ayushman Bharat cover as well. |
What is the Significance of the Expanded Health Cover for Senior Citizens?
1. Expansion of Health Care ambit for Senior Citizens- According to the India Ageing Report 2023 barely 20% of India’s population above the age of 60 is currently covered by any government, employer-provided, or personal insurance scheme. Extension of the ambit of the world’s publicly-funded health assurance scheme is a crucial step towards ensuring a more fulfilling life for the senior citizens in India.
2. Increasing elderly population in India- According to the government’s Longitudinal Ageing Study in India (LASI), the percentage of elderly population over the age of 60 years is set to increase to 19.5% by 2050 from 8.6% in 2011. In terms of numbers, Indians over the age of 60 are likely to be 319 million in 2050, which will be three times from the 103 million in 2011. This will increase the geriatric health care needs in India.
3. Increase in hospitalisation rates among elderly- The rate of admission among the elderly already covered under the AB PM-JAY scheme has been more than 7%, which is double the 3-4% admission rate for the younger people covered under the scheme.
4. Gender Justice by catering to elderly women- According to a survey by NITI Aayog, women constitute the larger share of the elderly population, with 58% of the elderly being women, and 54% among them being widows. The extension of health cover will provide immense help to women, and especially widowed women.
5. Reduction of the out-of-pocket health care expenditure- This will help in reducing the out-of-pocket expenditure (OOPE) for senior citizens, as the OOPE for health care in India is among the highest in the world.
What are the challenges that remain despite the expansion of health coverage?
1. Low penetration of AB PM-JAY- There has been a lower penetration of PM-JAY into smaller cities and towns in most states, since its launch in 2018. This lower penetration will create a challenge in achieving universalisation of health care needs of the elderly.
2. Absence of coverage of outpatient care- Most of the health-care expenditure by the elderly is through outpatient care (40%-80%). The absence of coverage for outpatient care, diagnostics, and medicines for the elderly is particularly concerning as chronic diseases have increased sharply in India in the last few decades.
3. Limitation of the scheme to secondary and tertiary care hospitalisation- The expanded health assurance scheme remains limited to secondary and tertiary care hospitalisation. The primary and secondary health care in the public sector remains largely inadequate and ill-equipped to meet the demands of the senior citizens.
4. Functional challenges with AB PM-JAY- There are serious functioning challenges in the implementation of AB PM-JAY, which are explained below-
a. Misinformation- There are numerous reports showing that doctors indulge in spreading misinformation to already stressed families of the grievously ill, that availing benefits under AB-PMJAY could take months.
b. Overburdened Staff- There are reports regarding the overburdened staff at government institutions not wanting to take on the additional task of filling up documents related to the insurance scheme.
c. Limited role of Arogyamitras- The role of Arogyamitras is limited to registering claims under the scheme. Their role has been limited in counselling relatives of patients.
5. Failure of insurance model over primary health care improvement- The reliance of U.S., on insurance-based schemes has led to the surging costs of health care. While Thailand on the other hand has focused on progressively strengthening its primary health-care system and attaining universal health coverage.
What Should be the Way Forward?
1. Improvement in AB PM-JAY’s functioning- The Arogya mitras should be empowered to handhold patients in cases of claim settlement and ironing out of glitches.
2. Expansion of Health care infrastructure- According to NITI Aayog’s report, the increased nuclearisation of families is making the senior citizens more vulnerable to health care needs. Policymakers should aim to improve the number of health care centres and to narrow down the doctor-patient asymmetry.
3. Increasing the robustness of primary and secondary public health care- Robust primary and secondary public health care will sharply cut the load on tertiary health care and the need for curative care. A reduced curative care load at tertiary hospitals will help in the success of PM-JAY scheme.
4. Address the concerns of private health care providers- The concerns of the private sector, like low treatment rates and delayed payment, must be addressed at the earliest for the success of the health coverage of senior citizens.
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