Why in the news? (Ayushman Bharat Health Insurance)
Recently, the Central Government has extended the Ayushman Bharat Recently, the Central Government has expanded the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) to include health coverage for senior citizens aged 70 and above.
This move marks a crucial step towards achieving universal healthcare in the country. The annual health coverage of ₹5 lakh will benefit approximately six crore people, representing about 5 per cent of the current population.
What is the Status of the Elderly Population in India?
What are the Healthcare Concerns for Senior Citizens?
The elderly population in India, defined as those aged 60 and above, is projected to rise from 100 million in 2011 to 230 million by 2036.
By 2050, this demographic is expected to make up nearly one-fifth of the total population.
Increase in the Old-Age Dependence Ratio
The old-age dependence ratio reflects the number of individuals aged 60 and above per 100 people in the 15-59 age group.
The ‘Elderly in India 2021’ report by the Ministry of Statistics and Programme Implementation (MOSPI) indicates that this ratio has been on the rise.
It rose from 10.9% in 1961 to 14.2% in 2011 and is projected to reach 15.7% in 2021 and 20.1% in 2031.
Healthcare Concerns for Senior Citizens
- Increase in Age-Related Chronic Illnesses: The Longitudinal Ageing Study of India (LASI) 2021 reveals that one in five elderly individuals in India faces mental health issues, with around 75 percent suffering from chronic diseases.
- Growing Demand for Geriatric Care: The rising costs associated with treating conditions such as non-communicable diseases, cataracts, and hearing loss pose financial challenges for the elderly population.
Beneficiaries:
- Individuals who are 70 years old according to their Aadhaar can enroll for the new health cover.
- People aged 70 and above will receive an annual health cover of Rs 5 lakh, which will be distributed among family members. For example, if there are two elderly beneficiaries in the same household, the cover amount will be divided between them.
- Elderly members (70 years and older) of families already covered based on their economic status will receive an additional Rs 5 lakh top-up cover specifically for their needs. These beneficiaries will need to re-register to obtain the top-up cover.
Registration:
- Beneficiaries can register via the government’s Ayushman App or at the Ayushman Bharat counter located in any government health facility.
- Once beneficiaries complete their eKYC, they can immediately use their policy. The portal will also support face authorization to accommodate elderly individuals whose fingerprints may be difficult to read or have changed over time.
Exclusions and Inclusions:
- Options for Those Already Covered: Approximately 80 lakh individuals are already covered under various government health schemes, such as the Central Government Health Scheme (CGHS), Ex-Servicemen Contributory Health Scheme, or coverage for the family members of defense and railway personnel. Those with existing coverage under these schemes can choose between Ayushman Bharat or maintaining their current insurance.
- Inclusion of ESIC Beneficiaries: Individuals covered by the Employees State Insurance Corporation (ESIC) are eligible to receive both their existing ESIC coverage and Ayushman Bharat, as ESIC premiums are paid by the insured and their employer, not by the government.
- Private Insurance Holders: Those with privately purchased insurance can also benefit from the Ayushman Bharat cover.
What are the details of the expanded Health Cover for Senior Citizens?
AB PM-JAY: AB PM-JAY is currently the world’s largest public health insurance scheme. It offers free coverage of up to ₹5 lakh annually to all members of eligible families, which include the bottom 40% of the population economically, regardless of age.
Expansion of Health Coverage under AB PM-JAY: The health coverage for senior citizens under Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) has been broadened. The expanded scheme will now cover nearly 6 crore individuals (from 4.5 crore families), with 1.78 crore already covered under the existing scheme.
What is the Significance of the Expanded Health Coverage for Senior Citizens?
- Broadened Healthcare Coverage for Seniors: According to the India Ageing Report 2023, only 20% of India’s population over 60 is currently covered by any form of insurance—be it government, employer-provided, or personal. Expanding the world’s largest publicly-funded health assurance scheme is a critical step towards ensuring a more secure and fulfilling life for India’s senior citizens.
- Rising Elderly Population in India: The government’s Longitudinal Ageing Study of India (LASI) projects that the percentage of people over 60 will rise to 19.5% by 2050, up from 8.6% in 2011. The number of elderly individuals is expected to reach 319 million by 2050, a threefold increase from 103 million in 2011. This growth will significantly heighten the demand for geriatric healthcare services.
- Increased Hospitalization Rates Among the Elderly: The hospitalization rate for elderly individuals already covered under the AB PM-JAY scheme exceeds 7%, which is double the 3-4% admission rate for younger beneficiaries of the scheme.
- Promoting Gender Justice for Elderly Women: A NITI Aayog survey indicates that women make up 58% of the elderly population, with 54% of them being widows. The expanded health coverage will provide substantial support to elderly women, particularly widows.
- Reduction in Out-of-Pocket Healthcare Expenses: The extension of health coverage will help reduce out-of-pocket healthcare costs for senior citizens, addressing a significant issue in India where such expenses are among the highest globally
Challenges in Health Coverage:
- Limited Reach of AB PM-JAY: Since its launch in 2018, AB PM-JAY has had low penetration in smaller cities and towns across many states. This limited reach poses a challenge to achieving universal healthcare coverage for the elderly.
- Lack of Outpatient Care Coverage: A significant portion of healthcare expenses for the elderly—ranging from 40% to 80%—is incurred through outpatient care. The absence of coverage for outpatient services, diagnostics, and medications is a major concern, especially given the rise in chronic diseases in India over recent decades.
- Focus on Secondary and Tertiary Care: The expanded health coverage under the scheme is restricted to secondary and tertiary care hospitalizations. Primary and secondary healthcare services in the public sector are still largely inadequate and ill-equipped to address the needs of senior citizens.
- Operational Challenges with AB PM-JAY:
- Misinformation: There are reports of doctors providing misleading information to families of seriously ill patients, suggesting that benefits under AB PM-JAY might take months to avail.
- Overburdened Staff: Staff at government institutions are reported to be overwhelmed and reluctant to handle additional paperwork related to the insurance scheme.
- Limited Role of Arogyamitras: Arogyamitras are primarily involved in registering claims under the scheme and have a limited role in providing counseling to patients’ relatives.
- Shortcomings of the Insurance Model: The U.S. experience with insurance-based schemes has led to rising healthcare costs, whereas Thailand’s approach of focusing on strengthening primary healthcare systems has successfully advanced universal health coverage.
Recommended Actions:
- Enhance AB PM-JAY Operations: Empower Arogya Mitras to assist patients with claim settlements and resolve any issues that arise to improve the functioning of the scheme.
- Expand Healthcare Infrastructure: Given the increasing nuclearization of families and the growing vulnerability of senior citizens, policymakers should focus on increasing the number of healthcare centres and addressing disparities between doctors and patients.
- Strengthen Primary and Secondary Public Healthcare: Enhancing primary and secondary public healthcare services will alleviate the burden on tertiary care facilities, thereby supporting the effectiveness of the PM-JAY scheme.
- Address Issues with Private Healthcare Providers: Resolve concerns related to private healthcare providers, such as low treatment rates and delayed payments, to ensure the success of health coverage for senior citizens.
Explore our courses: https://apnipathshala.com/courses/
Explore Our test Series: https://tests.apnipathshala.com/
