In a significant policy shift, the Indian government has recently expanded the Ayushman Bharat health insurance scheme to include all citizens aged 70 and above, irrespective of income level. This decision, announced last week, was one of the most notable updates in the latest cabinet meeting. Previously, the Pradhan Mantri Jan Arogya Yojana (PM-JAY), which operates under the broader Ayushman Bharat umbrella, provided a health cover of ₹5 lakh per family annually, but only to the bottom 40% of India’s population. The extension of coverage to senior citizens across all income groups marks a pivotal shift in the country’s approach to healthcare.
While this expansion promises to provide much-needed relief to India’s aging population, concerns remain about whether Ayushman Bharat, in its current form, can meet the expectations and effectively manage this new challenge. India’s healthcare system already faces various structural issues, and the rising demands of elderly care only add to these complexities. This journal explores the potential and challenges of this new promise and examines whether Ayushman Bharat is equipped to fulfill its expanded role.
Ayushman Bharat’s Vision: Past Achievements
Launched in 2018, Ayushman Bharat PM-JAY was envisioned as a means to bring affordable healthcare to the most vulnerable segments of the population. With a primary focus on the economically weaker sections, the scheme targeted 500 million individuals across the country, providing them with an annual health insurance cover of ₹5 lakh per family. The idea was to help alleviate the burden of catastrophic healthcare costs, which frequently push low-income families into poverty.
The initiative has achieved notable success in increasing healthcare accessibility for low-income households. By offering coverage for secondary and tertiary healthcare, it helped reduce out-of-pocket expenditures and improved access to expensive treatments such as surgeries and hospitalization. Ayushman Bharat also placed a spotlight on public healthcare facilities, driving improvements in infrastructure and quality of care.
However, from its inception, the scheme faced hurdles such as inadequate hospital infrastructure, inconsistent quality of care, and a lack of awareness among beneficiaries. These limitations, coupled with the financial constraints faced by the public healthcare system, left much to be desired in terms of the scheme’s efficiency and reach. Nevertheless, the introduction of Ayushman Bharat remains a milestone in India’s quest for Universal Health Coverage (UHC).
A Bold Move: Expanding to Senior Citizens
India’s elderly population is growing at a rapid rate, with government projections estimating that the number of senior citizens will more than double by 2050, reaching around 319 million. With life expectancy increasing and healthcare needs becoming more complex, this demographic shift poses significant challenges to the country’s healthcare system.
The government’s decision to extend Ayushman Bharat to all citizens aged 70 and above is a recognition of the unique healthcare needs of the elderly. Unlike younger populations, senior citizens are more prone to chronic illnesses such as diabetes, hypertension, cardiovascular diseases, and cancer, which require frequent and costly medical attention. The rising cost of healthcare, especially for these conditions, often places a significant financial strain on families.
By offering a health insurance cover of ₹5 lakh to senior citizens, regardless of their income, the government aims to ease this burden and ensure that the elderly receive the medical care they need. For many, particularly those in the middle-income group who may not qualify for previous welfare schemes, this extension of benefits could be a crucial safety net.
The Challenges Ahead
While the government’s decision to extend the scheme to all elderly citizens is laudable, several challenges could undermine its success. These challenges include financial sustainability, infrastructural constraints, and logistical complexities.
1. Financial Strain on the Government
One of the most immediate concerns is the financial strain that this expansion could place on government resources. By extending health coverage to all citizens aged 70 and above, the pool of beneficiaries will expand significantly. Healthcare costs for the elderly are generally much higher due to their increased need for medical care, leading to the possibility of a sharp rise in the cost of the scheme.
The current Ayushman Bharat scheme is funded jointly by the central and state governments. Adding millions of elderly individuals to the scheme may require a substantial increase in funding. To maintain financial sustainability, the government may need to explore new revenue sources or adjust the scope of services covered under the scheme. Failure to manage the financial aspect effectively could lead to reduced quality of care or rationing of services, thereby diminishing the scheme’s impact.
2. Inadequate Healthcare Infrastructure
Another major challenge is India’s existing healthcare infrastructure, which is already under pressure. Many public hospitals, especially in rural areas, lack the necessary equipment, facilities, and trained personnel to deliver high-quality care. For the scheme to be effective in reaching elderly citizens, it must address the issue of healthcare infrastructure, particularly in underserved regions.
India’s healthcare system also faces a shortage of specialized care for the elderly. Geriatric care, which involves the treatment and management of age-related diseases, is still a relatively underdeveloped field in the country. Without investing in building the infrastructure and workforce needed to support geriatric care, the government may struggle to deliver on its promise of providing effective healthcare for the elderly.
3. Private Sector Participation
While Ayushman Bharat allows beneficiaries to seek treatment in private hospitals, there have been reports of reluctance from private healthcare providers to fully participate in the scheme. Many private hospitals have raised concerns about the reimbursement rates offered under the program, claiming that they are too low to cover their costs, particularly for high-end medical procedures.
With the expansion of the scheme to the elderly, who often require more complex and expensive treatments, private sector participation will become even more crucial. The government may need to reassess its reimbursement structure to ensure that private hospitals are willing to offer services under the scheme. Without sufficient participation from private hospitals, especially in urban areas where many specialized treatments are available, the effectiveness of the scheme could be compromised.
Addressing the Needs of the Elderly Population
To fulfill its new promise of providing healthcare to all citizens aged 70 and above, the government will need to adopt a multi-pronged approach that addresses both immediate and long-term challenges.
1. Investing in Preventive Healthcare
Preventive care is critical for reducing healthcare costs in the long run. Many chronic diseases that affect the elderly can be managed or delayed with early detection and proper lifestyle interventions. The government should consider expanding preventive health services under Ayushman Bharat, such as offering free or subsidized health checkups, screenings, and wellness programs for senior citizens.
2. Expanding Geriatric Care Capacity
India will need to significantly enhance its capacity for geriatric care by training more healthcare professionals in the field and improving the quality of care available to the elderly. This could include expanding medical education programs focused on geriatrics, investing in the development of age-friendly healthcare facilities, and increasing the number of healthcare workers trained in elderly care.
3. Leveraging Technology for Healthcare Delivery
Innovative technologies, such as telemedicine, can help overcome the challenges of limited infrastructure and healthcare personnel, particularly in rural areas. Telemedicine services could allow elderly patients to access medical consultations and receive treatment without needing to travel long distances. This approach could also help bridge the gap between urban and rural healthcare access.
A Positive Step with Much Work Ahead
The extension of Ayushman Bharat to all citizens aged 70 and above represents a significant step in India’s journey toward more inclusive healthcare. However, the success of this expansion will depend on the government’s ability to address financial, infrastructural, and logistical challenges. Investments in healthcare infrastructure, especially in geriatric care, along with policy adjustments to ensure private sector participation, will be crucial for the scheme to fulfill its new promise.
By tackling these issues, Ayushman Bharat can provide meaningful healthcare support to India’s elderly population, ensuring that they have access to quality medical services in their later years. This expansion, if implemented effectively, could serve as a vital component of India’s broader push toward Universal Health Coverage, benefiting not just the elderly but society as a whole.
Disclaimer: The thoughts and opinions stated in this article are solely those of the author and do not necessarily reflect the views or positions of any entities represented and we recommend referring to more recent and reliable sources for up-to-date information.
