Lacunae in Ayushman Bharat
The largest public healthcare scheme in India lacks provisions for the elderly
A 'senior citizen' means any person being a citizen of India who has attained the age of sixty years. Population Census of 2011 revealed that there are nearly 104 million elderly persons (aged 60 years or above) in India; the number of elderly persons is expected to grow to 173 million by 2026.
Growing age has several new challenges. Physical capacities come down; mental faculties to start facing a downward trend. The person is more prone to fall prey to various types of diseases. The list of the risks, including illnesses, disorders, ailments, maladies, and diseases associated with old age, is quite long. Through various researches, around 125 diseases have been identified to be directly connected with this age group. But some of the important and more challenging illnesses need to be taken care of on a priority basis. Diseases affecting heart, chest, and nervous system are more common and incapacitating. A review of the common ailments of elderly age tells us about the level of the problem.
Arthritis is a very common condition that the older people suffer from. It can lead to pain in the joints lowering the quality of life, which seriously affects the physical and mental status of a person. Heart diseases are the leading killers of persons above the age of 65. Cancer is the second leading cause of death. This incapacitates the person who has to pay repeated hospital visits requiring expensive investigations, monitoring and medical or surgical intervention for long periods of time. Respiratory diseases are the third common cause of death among the elderly, who are more vulnerable to pneumonia and other infections. Cerebrovascular accidents occur as a result of leakage or clotting of blood in brain or tumours in the cranium. A person may develop paralysis. His quality of life becomes very poor, even miserable. The person becomes dependent on others. This becomes a cause of serious psychological disturbance and a matter of stress for the whole family. Parkinsonism hampers the person's capabilities and gradually cripples the physical capacities. Alzheimer's disease occurs because of the degenerative process of the brain; the patient develops cognitive impairment and is unable to take care of himself. He is a concern to the family for safety and cost involved. Osteoporosis makes bones brittle and the person is more likely to develop fracture of any bone.
Diabetes is increasing in our country. Those who had developed diabetes at an early age develop several complications by the time they reach the elderly age. Complications may be related to the nervous system, heart, kidney, muscles, and other body systems. Infections occur more commonly in this age group because of lowering of resistance. Sometimes these may prove to be fatal.
Depression is an increasing problem in our country, which is occurring as a result of changing family relations, increase in the cost of healthcare, physical incapacities which increase with the age, and a person's dependence on his siblings. Losing one's life partner causes loneliness and isolation leading to depression.
Poverty affects senior citizens' health. Older women are slightly more likely to be living in poverty than men, and that gap widens in those over 80.
Most of the diseases that occur at this age are chronic in nature. They recover from one illness and fall prey to some other. This demands repeated visits to the doctors. At a time when the earnings have come down substantially or have become nil, it becomes difficult for them to bear with such expenses. Many a time, the elderly persons do not talk of their illness in the initial stages because they do not want to put the burden on children. But at a later stage when the disease has progressed, the agony of the disease and the cost of treatment increase. This adds to the problems and the humiliation.
Most of these diseases need regular OPD care. It is important that the healthcare needs are met without burdening them financially. Ironically, Ayushman Bharat talks of coverage of only 50 crore people. The rest of about 80 crore people are left out. Very few of this 80 crore population has resources enough to support their healthcare needs. As most of the healthcare expenditure is in the OPD care, even those who are covered under the scheme will not benefit much. Elderly have special nutritional needs, which need to be fulfilled. In Ayushman Bharat, there is no such mention of these requirements. Ayushman Bharat should take care of the elderly. It should be clear that all of them, irrespective of socio-economic status, must get comprehensive healthcare free of cost right from preventive care, OPD care, and in patient treatment up to tertiary level. This is the period of life when one needs maximum empathy and special care with no worry of the cost involved.
(Dr. Arun Mitra is Senior Vice President, Indian Doctors for Peace and Development. The views expressed are strictly personal)
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