A shot in the arm
The Union Cabinet’s approval of the expansion of the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) to include all citizens aged 70 and above, irrespective of their income level, is a big move in India's public healthcare landscape. The decision is being seen as a fulfilment of ruling BJP’s poll promise. However, its scope and relevance cannot be seen through the limited lens of politics. In the first place, the rollout of the AB PM-JAY in September 2018, despite certain shortcomings, was a pioneering endeavour in itself with the promise of solving the healthcare needs of a burgeoning population, particularly the economically vulnerable ones. The Cabinet’s recent approval for the expansion of the scheme is an expression of intent towards realising that promise on the ground. There is not an iota of doubt that the scheme can potentially address the healthcare anxieties faced by India’s rapidly aging population.
Earlier this year, NITI Aayog released a position paper titled ‘Senior Care Reforms in India: Reimagining the Senior Care Paradigm’, in which it reported that India is witnessing exponential growth in the number and proportion of elderly people, coupled with a decreasing fertility rate and increasing life expectancy. This is corroborated by the United Nations Population Fund (UNFPA) estimates, which project that India’s elderly population share will increase from a little over 10 per cent presently to 19.5 per cent by 2050. Not only is this elderly population increasing, but the prevalence of chronic diseases among them is also significant. As per the Longitudinal Ageing Study of India (LASI) report, 2021, a significant portion of the elderly population suffers from chronic diseases, functional limitations, depressive symptoms, and low life satisfaction. While 75 per cent of the elderly have one or more chronic diseases, 32 per cent report low life satisfaction. It is against this backdrop that the Union Cabinet’s approval of the scheme expansion should be seen.
The coverage of an entire age cohort indicates the government’s intent towards materialising universal health coverage, suggesting that other age groups may also be covered eventually. However, despite its universal intent, the scheme is not without limitations. The health coverage of Rs 5 lakh per family is significant, but for a senior-heavy family, this amount may still fall short, necessitating progress on other complementary and fundamental attributes. As clarified by Union Information and Broadcasting Minister Ashwini Vaishnaw, if a family has more than one senior citizen aged 70 and above, the Rs 5 lakh coverage will be shared between them. This could lead to situations where the coverage might not be sufficient to cater to multiple hospitalisations or complex medical needs. Nevertheless, the beginning is appreciable. Additionally, while the scheme provides flexibility by allowing those covered under other public or private health schemes to choose between their existing coverage or AB PM-JAY, it may inadvertently create confusion. Choosing among multiple health policies can be daunting, particularly for senior citizens. Clear guidelines and support systems need to be established to help seniors make informed decisions about which scheme best meets their healthcare needs.
The real challenge, however, lies in managing the demand-driven nature of the scheme, where costs are expected to rise with increased hospitalisations and medical interventions. The outlay for the scheme, which is Rs 3,437 crore, may have to be scaled significantly, creating equal pressure on the finances of the state government. There is no doubt that the scheme aims to solve a daunting problem that even the most developed nations are grappling with. However, finances need to be planned with utmost clarity, so that the implementation of the programme does not suffer. Experts caution that expanding health coverage for all seniors over 70 may end up being more expensive than covering the bottom 40 per cent of the population.
The expansion of AB PM-JAY addresses a critical gap in geriatric care, an area long ignored in India’s health policy. However, the success of the scheme will ultimately rest on its implementation. Healthcare facilities, especially in rural and semi-urban areas, need to be strengthened to cater to the increased demand from senior citizens. Access to quality care, trained medical professionals, and transparent processes for availing insurance must also be ensured.
