18 September 2024 : Indian Express Editorial Analysis

1. Reaping the silver dividend

(Source: Indian Express; Section: The Editorial Page; Page: 10)

Topic: GS2– Social Justice – Health

Context:

The article discusses the Indian government’s extension of the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) to cover elderly adults, analyzing its potential impact on healthcare access and financial protection, while highlighting its limitations in promoting healthy aging.

About Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY)

• AB PM-JAY is the world’s largest publicly funded health assurance scheme, offering ₹5 lakh of coverage per family annually for secondary and tertiary care hospitalizations.
• It was launched in February 2018.
• It is a Centrally Sponsored Scheme having central sector component under the Ayushman Bharat Mission.
• It covers surgery, medical and day care treatments, cost of medicines and diagnostics.
• It covers up to 3 days of pre-hospitalization and 15 days post-hospitalization expenses.

• It currently covers 55 crore people from 12.34 crore families, providing comprehensive health benefits regardless of the family members’ age.
• 7.37 crore hospital admissions have been covered under the scheme, with 49% of the beneficiaries being women.

Expansion of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY)

• The Indian government’s recent decision to extend the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) to include a ₹5 lakh top-up for older adults above 70 years not covered by other public health insurance schemes is a step toward addressing the healthcare needs of the elderly.
• While the government claims that the initiative will benefit 4.5 crore families, this extension may not suffice to comprehensively protect households from catastrophic healthcare expenditures (CHE), especially among the elderly population.
• This analysis examines the adequacy of the scheme, its financial implications, and its potential role in promoting healthy aging.

Aging Population and Healthcare Needs in India

• India is not only the world’s most populous country but also among the fastest aging. Although life expectancy in the country is around 70 years, the healthy life expectancy (years lived without serious health problems) is just 63.5 years.
• With increasing prevalence of non-communicable diseases, disabilities, and a significant proportion of bedridden elderly, especially in the 70–80 and 80-plus age groups, healthcare coverage becomes critical.
• Private health insurance schemes impose heavy premiums and high-risk pooling mechanisms, which further limit access for the elderly. Currently, only one in five Indians above 60 years has health insurance.
• With a vast informal labor force (92% of the workforce), the financial burden of healthcare can lead to impoverishment for many households.

Financial Implications and Coverage Gaps

• Despite the government’s allocation of ₹3,437 crore to extend the AB-PMJAY to older adults, preliminary national and state-level estimates suggest that this amount is insufficient.
• Calculations using the projected population and hospitalization rates indicate that around 5.6 crore households are eligible, but after deducting those already covered by employer-based public health insurance schemes, the expected users amount to 43.5 lakh families.
• With an average hospitalization cost of ₹32,804 per year, the scheme would require ₹14,282 crore annually—four times the current allocation.
• The financial shortfall highlights a critical gap in the scheme’s ability to provide adequate coverage for elderly healthcare.
• Moreover, the scheme only covers secondary and tertiary care, leaving outpatient care—crucial for preventive health measures—unaddressed. This exclusion could limit the scheme’s potential to promote long-term healthy aging.

Challenges in Addressing Elderly Healthcare Needs

• Older adults, particularly those suffering from non-communicable diseases such as diabetes, cardiovascular issues, and respiratory conditions, require frequent healthcare consultations and often need long-term care.
• The AB-PMJAY, similar to most private health insurance schemes, does not cover outpatient care or palliative care—both vital for the elderly.
• The exclusion of outpatient services from the scheme is problematic, given that outpatient services constitute 46% of the total health expenditure and are crucial for preventive healthcare.
• The current framework of the scheme also fails to address the rising care needs of the elderly, particularly for those over 80 years old or those who are bedridden due to chronic illnesses.
• Without support for continuous and preventive care, the scheme’s long-term impact on promoting healthy aging remains limited.

Holistic Reforms for Healthcare Systems

• Expanding the AB-PMJAY to cover more older adults is a necessary step, but it is not enough to achieve the public health goals of India.
• Public healthcare spending has been stagnant at around 0.9% to 1.35% of the GDP for over seven decades, which hampers the growth of healthcare infrastructure and limits the availability of healthcare personnel and essential medicines.
• Countries with better healthcare outcomes, such as Canada, Europe, and Australia, view healthcare as a public service and invest substantially in health as human capital. In contrast, India’s reliance on insurance-based schemes risks inflating healthcare costs without improving outcomes significantly.

Conclusion: The Need for Comprehensive Reforms

• While the extension of AB-PMJAY is a crucial intervention to prevent impoverishment due to catastrophic health spending, it falls short of ensuring the well-being of the aging population.
• As India undergoes a demographic transition, which will alter the age structure and disease profile of the population, the current healthcare model will require more comprehensive reforms.
• Promoting healthy aging is essential for reaping the “silver dividend,” which refers to the economic and non-economic contributions made by the older population.
• A holistic approach, integrating primary, secondary, and tertiary care, is needed to support the elderly and prepare the healthcare system for the challenges of an aging society.

Health Care Concerns for Senior Citizens

Rise in Chronic Illness: 1 in 5 elderly persons has mental health issues, with 75% suffering from chronic diseases (LASI, 2021). Need for Geriatric Care: Increased expenses for treating non-communicable diseases and conditions like cataracts and hearing loss create financial challenges. Low AB PM-JAY Penetration: Limited reach in smaller cities and towns hampers universal health coverage. Lack of Outpatient Care: No coverage for outpatient services and medicines, despite high elderly spending on chronic diseases. Limited to Hospitalization: Focus on secondary and tertiary care; inadequate primary health care for seniors. Functional Issues: Misinformation, overburdened staff, and limited role of Arogyamitras affect AB PM-JAY’s effectiveness. Insurance Model Limitations: Over-reliance on insurance schemes, unlike models focusing on primary care, can lead to higher costs.

Practice Question:  Discuss the recent extension of the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) for older adults above 70 years. Evaluate its potential impact on healthcare access and financial protection for the elderly, and suggest additional measures needed to promote healthy aging in India. (250 words/15 m)