Introduction
The Central Government has recently expanded the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) to include senior citizens above the age of 70. This move marks a significant advancement toward universal healthcare in India. The scheme now offers an annual health coverage of Rs 5 lakh, benefiting approximately six crore people—around 5 percent of the country’s current population.
Status of Elderly Population in India
- Increasing Elderly Population: The elderly population in India (those aged 60+) is projected to rise significantly, from 100 million in 2011 to 230 million by 2036. By 2050, nearly one-fifth of India’s population will be elderly, highlighting the growing importance of geriatric care.
- Old-Age Dependency Ratio: The old-age dependency ratio, which measures the number of elderly per 100 working-age individuals, is rising. From 10.9% in 1961, it increased to 14.2% in 2011 and is expected to reach 20.1% by 2031. This indicates an increasing burden on the working population to support the elderly.
- Elderly in India 2021 Report (Ministry of Statistics and Programme Implementation): This report provides data on the growing elderly population, projecting that the elderly population will rise from 8.6% in 2011 to nearly 20% by 2050. It also highlights the increasing old-age dependency ratio and calls for expanded social protection and healthcare services for senior citizens.
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Health Care Concerns of Senior Citizens
Rise in Age-related Chronic Illnesses:
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- According to the Longitudinal Ageing Study of India (LASI) in 2021, one in five elderly persons in India has mental health issues, and 75% suffer from chronic illnesses such as hypertension, diabetes, cardiovascular diseases, and arthritis. These conditions require long-term care, adding to the healthcare burden.
Increasing Need for Geriatric Care:
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- With the rise in Non-Communicable Diseases (NCDs) like diabetes, cataracts, and hearing loss, elderly individuals face increased health expenses. This financial burden is heightened by the fact that many elderly citizens lack sufficient health insurance.
Rising Prevalence of Disabilities:
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- The LASI report also reveals that 27% of elderly people suffer from disabilities, such as vision, hearing impairments, and mobility issues. The need for assistive devices and rehabilitation services adds to the economic pressure on both individuals and families.
Mental Health and Cognitive Disorders:
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- Mental health concerns like depression, anxiety, and cognitive decline are prevalent. According to the India Ageing Report 2023, 20% of elderly individuals face depression, while dementia affects over 4.4 million seniors, indicating a critical public health concern.
Healthcare Access and Infrastructure Challenges:
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- Around 70% of India’s elderly population resides in rural areas, where access to healthcare facilities is limited. The Ministry of Health and Family Welfare highlights that many elderly people in these areas are deprived of basic healthcare services, leading to delays in treatment.
High Out-of-pocket Expenditure (OOPE):
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- Elderly individuals face substantial healthcare costs, with out-of-pocket expenditure constituting nearly 60% of total health expenses, as reported in the National Health Profile 2020. This places a heavy financial burden on elderly citizens and their families.
Lack of Preventive Health Services:
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- The elderly population in India has limited access to preventive healthcare, such as regular screenings for chronic conditions. According to the World Health Organization (WHO), only 26% of elderly individuals receive routine preventive care, leading to delayed diagnosis of critical health issues.
Initiatives for Senior Citizens
AB PM-JAY Scheme:
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- The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) is the world’s largest public health insurance scheme, providing free coverage of up to Rs. 5 lakh annually for eligible families. It is vital for the elderly, who face high medical expenses. This scheme covers 10 crore poor and vulnerable families, ensuring access to secondary and tertiary healthcare services.
Expanded Health Coverage for Senior Citizens:
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- Under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY), the health coverage for senior citizens has been significantly expanded. The revised scheme will now cover nearly 6 crore individuals, drawn from 4.5 crore families, with 1.78 crore elderly beneficiaries already covered.
Aadhaar-linked Registration:
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- Any individual aged 70 or above, based on their Aadhaar data, is eligible to register for the new extended health coverage under the scheme.
Rs. 5 Lakh Annual Cover:
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- All individuals aged 70 or older will be entitled to Rs. 5 lakh in annual health coverage, shared among family members. If there are multiple elderly individuals in a household, the cover will be split between them.
Top-up for Economically Eligible Families:
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- Elderly individuals (70 years and above) from families already covered under the scheme, based on economic criteria, will receive an additional top-up of Rs. 5 lakh, specifically for senior members. These beneficiaries must re-register to access this top-up benefit.
Digital and In-person Options:
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- Beneficiaries can register either through the government’s Ayushman App or by visiting Ayushman Bharat counters at government health facilities.
eKYC and Face Authentication:
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- n to ensure all elderly individuals can access benefits.
Already Covered Individuals:
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- Around 80 lakh individuals are separately covered under various government health schemes like the Central Government Health Scheme (CGHS), Ex-Servicemen Contributory Health Scheme (ECHS), or insurance provided to family members of defense and railway personnel. These beneficiaries have the option to choose between Ayushman Bharat or continuing with their existing health coverage.
ESIC-covered Individuals:
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- Those who are part of the Employees State Insurance Corporation (ESIC) will be eligible for both their existing insurance and the Ayushman Bharat coverage, as ESIC is funded by premiums paid by the insured and their employers.
Private Insurance Holders:
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- Individuals who have purchased private health insurance will also be eligible to receive the benefits of Ayushman Bharat in addition to their existing private insurance coverage.
Rashtriya Vayoshri Yojana (RVY):
- Launched in 2017, this scheme provides physical aids and assistive devices to senior citizens from the Below Poverty Line (BPL) category. Devices such as wheelchairs, hearing aids, and walking sticks are provided to improve mobility and quality of life for elderly citizens with disabilities.
Pradhan Mantri Vaya Vandana Yojana (PMVVY):
- This pension scheme provides a steady income to senior citizens, ensuring they can afford medical expenses during their retirement years. It plays an indirect role in improving healthcare affordability for elderly individuals.
National Programme for Health Care of the Elderly (NPHCE):
- This programme aims to provide comprehensive healthcare to senior citizens, offering preventive, curative, and rehabilitative services across various healthcare levels. It also focuses on training healthcare professionals in geriatric care.
Senior Citizen Health Insurance Scheme (SCHIS):
- Under this scheme, senior citizens from BPL families are covered for Rs. 30,000 under the Rashtriya Swasthya Bima Yojana (RSBY). It includes coverage for pre-existing conditions, surgeries, and hospitalization, providing financial relief to vulnerable elderly individuals.
Significance of Expanded Health Coverage
- Broader Coverage for Seniors: According to the India Ageing Report 2023, only 20% of seniors are covered by insurance. Expanding AB PM-JAY’s reach is a crucial step in ensuring greater healthcare access for the growing elderly population.
- Increased Hospitalization Rates: Elderly citizens have a higher hospitalization rate (7%) compared to younger individuals under the scheme (3-4%), indicating their greater need for specialized care. This makes the expanded coverage even more essential for their wellbeing.
- Gender Justice: A significant portion of India’s elderly population comprises women (58%), many of whom are widows. Extending health coverage helps address the health and financial vulnerabilities of elderly women, especially those living alone.
- Reduction in Out-of-Pocket Expenditure: With India having one of the world’s highest out-of-pocket healthcare expenses, the expanded health coverage for senior citizens will help reduce this burden and increase access to necessary medical services.
Challenges in Health Coverage for Senior Citizens
Low Penetration in Rural Areas:
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- Despite the large scale of the AB PM-JAY scheme, its reach in rural areas and smaller towns remains limited. For instance, states like Bihar and Uttar Pradesh have reported lower enrolment rates compared to urban centers like Delhi and Maharashtra. This creates a significant challenge in ensuring universal healthcare access for elderly individuals residing in rural regions where healthcare infrastructure is already weak.
- A study by the National Health Authority (NHA) found that in certain districts of Madhya Pradesh, less than 50% of eligible elderly beneficiaries were enrolled under the scheme, indicating a rural-urban divide in access.
Lack of Outpatient Care:
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- While AB PM-JAY covers hospitalization costs, it does not include outpatient services, which form the bulk of healthcare expenses for elderly citizens. Given the rise in chronic diseases such as diabetes and hypertension, the lack of coverage for outpatient treatments like regular doctor visits, diagnostic tests, and medications creates a substantial gap in elderly care.
- In Tamil Nadu, many senior citizens rely on outpatient services for managing chronic conditions, but they face significant out-of-pocket expenses due to the absence of outpatient care under the scheme. This leaves gaps in care for those managing long-term illnesses without frequent hospitalizations.
Focus on Secondary and Tertiary Care:
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- AB PM-JAY primarily focuses on secondary and tertiary healthcare, while primary healthcare centers (PHCs), which are the first point of contact for many elderly patients, remain underfunded and poorly equipped. This mismatch in healthcare provision leads to bottlenecks at higher-level hospitals, as elderly individuals often skip the primary care stage due to the lack of proper facilities.
- In states like Odisha and Jharkhand, PHCs lack basic diagnostic tools and trained personnel, forcing elderly patients to travel long distances to district hospitals, which are already overwhelmed. This is particularly problematic for conditions that require regular monitoring, such as heart disease or arthritis.
Functional Inefficiencies:
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- Operational challenges within AB PM-JAY reduce its effectiveness for elderly beneficiaries. There have been reports of misinformation where families are told by some hospital staff that it takes months to avail benefits, leading to delayed treatments. Additionally, Arogyamitras, the frontline workers responsible for registering claims, often lack the capacity to handle the administrative burden, further hindering access for the elderly.
- In Rajasthan, elderly patients have reported being turned away by hospitals because they were wrongly informed that their treatment would not be covered under AB PM-JAY. This misinformation exacerbates the already complex healthcare landscape for senior citizens.
Dependence on Insurance Model:
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- Relying on an insurance-based healthcare model may not adequately meet the diverse needs of the elderly. The U.S. healthcare system, which heavily relies on insurance-based schemes, has seen escalating healthcare costs, with many elderly individuals facing financial hardships despite having insurance. In contrast, Thailand has achieved near-universal health coverage by investing in primary healthcare infrastructure, ensuring that senior citizens receive adequate care without high out-of-pocket expenses.
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Way Forward
- Improve AB PM-JAY’s Functioning: Empower Arogyamitras to provide better support to patients during claim settlement, ensuring that elderly beneficiaries have smooth access to healthcare.
- Expand Healthcare Infrastructure: Policymakers must address the growing healthcare needs of the elderly by expanding healthcare infrastructure, especially in rural areas, and resolving the doctor-patient asymmetry.
- Strengthen Primary Health Care: Building robust primary and secondary healthcare systems will reduce the load on tertiary hospitals and improve healthcare outcomes for senior citizens.
- Address Private Sector Concerns: Private healthcare providers’ issues, such as low treatment rates and delayed payments, must be addressed for the successful implementation of health coverage schemes for senior citizens.