The Union government's decision to extend the coverage of
Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) to senior citizens
over 70 years, regardless of their income, appears to be a progressive step.
This expansion provides Rs 5 lakh annual health coverage to nearly 60 million
people, aiming to ease the financial burden of health care for the elderly.
However, while the decision is laudable on the surface, it raises significant
concerns about the deeper structural issues in India’s healthcare system and
the limited impact this scheme will have on public health outcomes.
First, the scheme’s focus on secondary and tertiary care,
while necessary, overlooks a critical aspect of healthcare for senior citizens:
outpatient care. As chronic diseases like diabetes, hypertension, and arthritis
become more prevalent, particularly among the elderly, the majority of
healthcare needs arise from outpatient visits, diagnostics, and medications.
Unfortunately, none of these are covered under the current AB PM-JAY. For
individuals over 70, who are more likely to suffer from multiple chronic
conditions, this omission leaves a substantial gap in healthcare coverage.
While the scheme may help reduce out-of-pocket expenses (OOPE) for
hospitalizations, the bulk of their daily medical costs, which often account
for 40-80% of healthcare spending, will remain untouched.
The regional disparities in the success of the AB PM-JAY
remain a significant hurdle. While southern states have a relatively robust
public health infrastructure, other regions, particularly in northern and
central India, suffer from inadequate primary and secondary healthcare
facilities. This imbalance reduces the scheme’s penetration in smaller towns
and rural areas, where health needs are often the greatest. Strengthening
primary and secondary healthcare infrastructure is essential for reducing the burden
on tertiary hospitals, where the most expensive treatments are concentrated.
Moreover, with India's rapidly aging population, the
government’s current approach falls short of addressing the demographic
transition. By 2050, a fifth of the population will be over 70, necessitating
far-reaching reforms in welfare policies. The current healthcare model is
reactive, offering coverage only after people have fallen seriously ill. What
India needs is a proactive system that emphasizes preventive care, regular
screenings, and early interventions, particularly for age-related diseases.
The reality is that without significant investments in
preventive and primary healthcare, the burden on tertiary care hospitals will
continue to grow, putting further strain on the AB PM-JAY and reducing its
overall effectiveness. To truly make a difference, the government must reframe
its healthcare policies to include outpatient services, strengthen primary care
infrastructure, and promote a health system that caters to the comprehensive
needs of the elderly. Only then can the promise of free healthcare for senior
citizens evolve into a meaningful step towards a healthier, more equitable
society.