Dipak Kurmi
(The writer can be reached at dipakkurmiglpltd@gmail.com)
In a landmark decision, the Union Cabinet has approved an ex-pansion of the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) to provide Rs 5 lakh health insurance coverage to all senior citizens aged 70 years and above, irrespective of their income levels. This significant move marks a major step forward in addressing the healthcare needs of India’s rapidly growing elderly population and reflects the government’s commitment to enhancing health security for its senior citizens.
The Growing Need for Elderly Healthcare: India is witnessing a demographic shift with its elderly population (60 years and above) projected to reach 20% of the total population by 2050, up from the current 10%. This increase underscores the growing burden of healthcare expenditures for families caring for their elderly members. Currently, a significant portion of the elderly population, excluding those receiving pensions, relies on family support to manage medical expenses. This heavy financial load has been exacerbated by rising healthcare costs and inflation, which have made private health insurance increasingly unaffordable for many.
The AB PM-JAY scheme, which was initially designed to cover 40% of the population at the lowest economic strata, will now provide additional relief to senior citizens. This extension will benefit approximately 4.5 crore families and 6 crore senior citizens, providing them with a much-needed cushion against medical expenses.
Key Features of the Expanded Scheme: Under the expanded scheme, senior citizens aged 70 years and above will receive a health insurance cover of Rs 5 lakh for secondary and tertiary hospitalization. This coverage will be provided on a family basis, meaning that if two eligible senior citizens are part of the same family, the cover amount will be divided between them. However, each senior citizen above 70 years of age will have access to an additional Rs 5 lakh cover, separate from any benefits available to younger family members.
The government plans to issue a new, distinct card under the AB PM-JAY to facilitate this coverage. This new card will ensure that senior citizens can access health services in any empaneled hospital across the country without the burden of out-of-pocket expenses. The scheme will provide cashless and paperless access to healthcare services, ensuring that beneficiaries receive care without financial strain.
Accessibility and Implementation: To ensure the successful implementation of this scheme, special provisions have been made for the elderly. Recognising that many senior citizens may face challenges with online registration, the government will offer doorstep registration and card delivery services for families without internet access. This approach is crucial for ensuring that elderly citizens, especially those living alone or away from their families, can easily access their benefits.
ASHA workers will be tasked with assisting eligible senior citizens with registration and card issuance. This community-based approach will help bridge gaps in access and provide personalised support to those who need it most.
Addressing challenges and recommendations: While the expanded coverage under AB PM-JAY is a significant advancement, there are challenges that need to be addressed to maximise the scheme’s effectiveness. The Parliamentary Standing Committee on Health and Family Welfare has highlighted several issues, including the cost of complex and high-end surgeries that may exceed the Rs 5 lakh coverage limit. The committee has recommended expanding the list of covered surgeries and procedures and regularly updating the health benefit package to reflect current market rates.
Additionally, disparities in the quality of healthcare services across different empaneled hospitals remain a concern. Strengthening public sector healthcare services is essential to ensure that all elderly citizens, regardless of their location, receive high-quality care. Improving the availability of doctors and healthcare personnel in public hospitals will also be critical in addressing the challenges faced by the elderly in accessing timely and effective medical care.
The Impact of the New Policy: The extension of Ayushman Bharat to all citizens above 70 years of age represents a transformative step in healthcare policy. For many senior citizens, especially those in rural or economically disadvantaged areas, this policy will offer not only financial relief but also dignity and security in their later years.
The new policy is expected to alleviate the financial burden associated with frequent and costly medical procedures such as dialysis, heart surgeries, and cancer treatments. By providing up to Rs 5 lakh in coverage, the scheme will help families avoid the difficult choice between depleting their savings and accessing necessary medical care.
The social implications of this policy are also significant. It promises to improve healthcare outcomes for elderly individuals who might otherwise face neglect or abandonment when they fall ill. The policy’s focus on inclusivity and accessibility marks a crucial step towards a more equitable healthcare system.
The Union Cabinet’s decision to extend Ayushman Bharat Pradhan Mantri Jan Arogya Yojana to all senior citizens above 70 years is a landmark initiative that addresses a critical need in India’s healthcare system. By providing comprehensive health insurance coverage, the scheme will reduce the financial strain on families and improve access to quality healthcare for millions of elderly citizens. As the policy is implemented, it will be important to monitor its impact and address any emerging challenges to ensure that it meets the needs of the elderly population effectively. This move not only reflects a significant advancement in health security but also underscores the government’s commitment to enhancing the quality of life for its senior citizens.