Impact of Ayushman Bharat Coverage Expansion

Context

The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) has recently been enlarged to comprise 70+ Ageing adding Rs 5 lakh every year health Insurance. This policy change will be of great advantage to about six crore senior citizens of the 4. 5 crore families. Though this extension can be an appreciable step towards sentient healthcare, questions still arise regarding its sufficiency for covering up the various problems faced by the geriatric population of India.

Overview of Ayushman Bharat Scheme

• Ayushman Bharat was started in September 2018 and it is a two tranchescheme to pay for secondary and tertiary treatments for 40 percent of the Indian population which is approximately 12 Crores families.
• There had been the extension of this scheme on September 11, 2024 by the Union Cabinet from income basis eligibility to all citizens who were of 70 years and above.
• The upgrade aims at increasing social security to old-age-group people and cater to the increasing elderly population in India, mentioned Union Minister Mr Ashwini Vaishnav.

Significance of the Extension

• Addressing the Needs of the Elderly: Expansion of healthcare insurance for the senior citizen with ₹ 5 lakh per year, which can help families to cope up with the increasing emerging expenses of healthcare for their aging relatives.
• Enhancing Access to Healthcare: This new coverage helps seniors in accessing healthcare especially those that have not been insured before with a card that eases access to prompt medical treatments.
• Promoting Preventive Healthcare: The elderly gain more financial security since they are likely to visit the doctor for a routine check-up rather than wait until when the ailment becomes complicated to treat saving money in the process.

Challenges and Limitations

• Coverage Limitations: In fact, it is necessary to consider this measure as a grateful step only partially, as it expands the coverage of insurance to senior citizens. The ₹5 lakh coverage is for families, which means if more than one senior citizen is alive in one family, the coverage has to be split among the husband, wife or kids. This may culminate into poor financial cover especially for families with many elderly people, especially when such individuals are stricken with terminal illnesses that warrant expensive treatment.
• Existing Health Insurance Schemes: A large number of senior citizens are already availing the benefits of other public health insurance programmes like CGHS, Ex-servicemen contributory etc.
• Implementation Challenges: The performance of the extended infrastructure depends on the general healthcare networks hence the implementation of the extended coverage. Some of these challenges may include; lack of adequate health facilities, long waiting lists and lack of qualified personnel which may slow down the implementation of the scheme. Furthermore, the government has to make sure that funds are channeled to such facilities to cater for the growing need among elderly people to access quality health services.

Financial Implications

• Government Expenditure: The extra coverage cost has been estimated to be a whopping ₹3,437 crore in the beginning. However, this investment is so warranted when it comes to the health security of senior citizens; however, it has implications on the future funding for health. As the population ages increase, the government will need to ensure that more funds are available to support and grow this scheme.
• Impact on the Insurance Sector: Moderate impact: The enhancement of AB PM-JAY is unlikely to considerably affect the private health insurers, since a significant population of the defined age group has insurance cover or is not privileged for health insurance schemes by most insurers. However the scheme does open up opportunities to insurers to formulate products that would suit the demography of the elderly population and certainly there is a possibility of changing the structure of the health insurance market in India.

The Path Forward

• Need for Comprehensive Policies: Even as AB PM-JAY has expanded to the senior citizens, this measure alone cannot plumb the depth of needs of the elderly Indian citizen. The social security, health insurance, geriatric care support and the other social service policies are the protective measures that help in enhancing the quality of life of the elderly people.
• Focus on Preventive and Geriatric Care: Hence, improving the quality and access to preventive health care services and geriatric care services is important to reduce the morbidity and mortality of elderly population. The government should, therefore, put emphasis and support the development of care facilities that will address the health needs of seniors, as they should receive adequate care and attention.
• Public Awareness and Education: Public health education on the utility of the scheme as well as how the healthcare system is structured is an area of importance with regards to optimising the Ayushman Bharat scheme. Such information campaigns will enable the elderly and their families to comprehend the available coverage forms and the procedures required in seeking for health care services.

Conclusion

The further expansion of the Ayushman Bharat scheme to cover senior citizens who are 70 years of age and above can be considered as the new vital development on the way to make the healthcare universal in India. This is laudable and important to fill a gap but it is crucial also to identify the restriction of this activity and the environment it is in. What is required is effective policies that cover health care, social security and preventive medicine for the geing population in India. While the country is still struggling with the future implications of the ageing population then it is going to take an integrated approach to health care in order to establish a healthier nation.

Source: The Hindu

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