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.