Extending Ayushman Bharat to Elderly: A Needed Boost, But More Reforms Needed

Why in the news?

The government recently extended the Ayushman Bharat health insurance scheme to cover adults above 70 years, benefiting 4.5 crore families, though concerns remain about its sufficiency for addressing elderly healthcare needs.

About the Extension of Ayushman Bharat:

  • Government extends Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) to adults aged 70+.
  • Scheme provides Rs 5 lakh insurance coverage, benefiting 5 crore families.
  • Intended to reduce out-of-pocket healthcare expenses and protect against impoverishment from catastrophic health expenditures.

Concerns with the Extension:

  • While beneficial, the scheme does not address outpatient care, which forms 46% of healthcare spending.
  • Hospitalisation costs are high, especially for the elderly; the allocated budget (Rs 3,437 crore) falls short of the estimated Rs 14,282 crore
  • Current coverage excludes long-term care and preventive services critical for healthy ageing.

Need for Broader Reforms:

  • To ensure healthy ageing, India needs public health infrastructure expansion, more healthcare workers, and a focus on primary care.
  • Countries like Canada and Europe view healthcare as a public service, integrating both primary and tertiary care for better health outcomes.

Key points :Ayushman Bharat Scheme

  • World’s Largest Health Assurance Scheme launched in
  • Based on the National Health Policy 2017, implemented by the Ministry of Health and Family Welfare (MoHFW).
  • Aim: Achieve Universal Health Coverage (UHC) with promotive, preventive, curative, palliative, and rehabilitative care.

Funding and Coverage

  • Funding: Centrally sponsored, shared by Central and State governments.
  • Coverage: Targets over 10 crore families (50 crore beneficiaries) based on the Socio-Economic Caste Census (SECC).

Components

  • Health and Wellness Centres (HWC): Provides comprehensive primary care, including non-communicable diseases and maternal services.
  • Pradhan Mantri Jan Arogya Yojana (PM-JAY):
    • 5 lakh per family annually for secondary and tertiary care hospitalisation.
    • Covers pre-hospitalization (3 days) and post-hospitalization (15 days)
    • No restrictions on family size, age, or gender.
    • Portability across India for cashless treatment at any empaneled hospital.

Ayushman Bharat Digital Mission (ABDM):

  • Launched in 2021 to provide Unique Digital Health IDs (UHID), allowing digital access to health records for hospitals and citizens.

Benefits and Significance:

  • Reduces catastrophic healthcare expenditures, which push 6 crore people into poverty annually.
  • Mitigates financial risks from health emergencies by providing cashless access to care at point-of-service.

About National Health Authority (NHA):

  • National Health Authority (NHA) is responsible for implementing Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY).
  • Designs strategy, builds technological infrastructure, and implements National Digital Health Mission.
  • Coordinates with State Health Agencies (SHAs) for state-level execution.

Sources Referred:

PIB, The Hindu, Indian Express, Hindustan Times