Health cover for elderly citizens

The Union Cabinet’s approval of the Rs 5 lakh health insurance coverage to all the senior citizens aged 70 years and above irrespective of income under the flagship scheme Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) is a landmark health security initiative for elderly people. This will reduce the heavy burden of out-of-pocket expenditures for crores of families who are without any insurance cover. The country’s elderly population (60 years and above) is projected to increase to 20% of the total population by 2050, from the current level of 10%. This is indicative of the growing healthcare expenditure for the families to take care of their elderly members in the coming decades. Except for those drawing pension benefits, the majority of the elderly population is financially dependent on their families for footing their medical bills. It is heartening to know that the AB PM-JAY will benefit about 4.5 crore families with 6 crore senior citizens. The flagship scheme will cover all senior citizens of 70 years and above, irrespective of their socio-economic status. The government plans to issue a new distinct card under AB PM-JAY to facilitate health cover of Rs 5 lakh for secondary and tertiary hospitalisation for each family. This implies if there are two senior citizens in the eligible group, then the cover amount will be divided between them. Currently, the AB PM-JAY covers 40% of the population at the lowest economic strata, and for those who are covered under the scheme, the elderly members of 70 years and above will get an additional cover of Rs 5 lakh for themselves, and they do not have to share it with other members of the family below the age of 70 years. The government has clarified that senior citizens of the eligible age who are under private health insurance policies or the Employees’ State Insurance scheme will be eligible to avail benefits under AB PM-JAY. Senior citizens of the age 70 years and above who are already availing benefits of other public health insurance schemes such as the Central Government Health Scheme (CGHS), the Ex-Servicemen Contributory Health Scheme (ECHS), and the and the Ayushman Central Armed Police Force (CAPF) may either choose their existing scheme or opt for AB PMJAY. The scheme provides cashless and paperless access to beneficiaries in any empaneled hospital in the country. National Sample Survey Organisation data reveals that high out-of-pocket health expenses compelled 24% of rural households and 18% of urban households to meet health expenses through borrowings, which subsequently pushed them to debt. Rising inflation has made it difficult for middle-class households to pay a higher premium for adequate health coverage of family members, and for them, universal health coverage for elderly citizens under AB PM-JAY irrespective of income level will be a huge relief. Issuing eligible beneficiaries are elderly people that, apart from being online registration, doorstep registration and delivery of AB PM-JAY cards in offline mode for families without internet access will spare them from the trouble of making visits to government offices to get those. New cards to eligible beneficiaries being hassle-free will be critical to successful implementation of the scheme. As eligible beneficiaries are elderly people, apart from being online registration, doorstep registration and delivery of AB PM-JAY cards in offline mode for families without internet access will spare them from the trouble of making visits to government offices to get those. Special provisions in the scheme to prioritise doorstep deliveries of the services for lonely senior citizens or elderly couples living away from their children will ensure that they are not deprived from the benefits of the scheme for not being able to complete due formalities. ASHA workers can be entrusted the responsibility in lieu of incentives to reach out to such elderly citizens for registration and issuing the cards and help them understand how to avail the benefits. The Parliamentary Standing Committee on Health and Family Welfare, during a review of the PMJAY scheme, found that some of the complex and high-end surgeries or treatment of chronic diseases cost more than Rs 5 lakh, and some costly surgeries and procedures are not covered by the Rs 5 lakh health cover. Some key recommendations made by the parliamentary panel that need to be implemented by the government include expanding the list of surgeries and procedures and revising the rates under the health benefit package of the scheme frequently to keep updated in accordance with the market rates. While health cover proposed to be provided is uniform for eligible beneficiaries, disparities in quality of healthcare in different empaneled hospitals present the hard realities of disparities in healthcare access. Strengthening public sector healthcare services, therefore, must remain a top priority to end the disparities and provide better treatment facilities to all elderly people. Stronger public sector healthcare is essential to reduce out-of-pocket health expenditures. When the hospitals remain chock-a-block for lack of adequate doctors and healthcare personnel, then for elderly citizens, availing healthcare services is quite challenging. Addressing such challenges must become part of the government intervention to increase health coverage for senior citizens.