Ayushman Bharat Pradhan Mantri Jan Arogya Yojana

Context:

While releasing its election manifesto for the 2024 Lok Sabha elections, a prominent political party promised to expand its Ayushman Bharat Health Insurance scheme to cover senior citizens.

Relevance:

GS II: Government policies and Interventions

Dimensions of the Article:

1. Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY)
2. Need for Ayushman Bharat for Senior Citizens

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

• Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) is the flagship scheme of the Union government as a part of the Indian government’s National Health Policy.
• AB-PMJAY provides a health cover of up to Rs. 5 lakh a family a year, for secondary and tertiary care hospitalization, to India’s bottom 40% poor and vulnerable population.
• The programme was launched in September, 2018.
• AB-PMJAY is under the aegis of Ministry of Health and Family Welfare.
• The PM Jan Arogya Yojana beneficiaries get an e-card that can be used to avail services at an empanelled hospital, public or private, anywhere in the country, with which they can walk into a hospital and obtain cashless treatment.
• The scheme has certain pre-conditions by which it picks who can avail of the health cover benefit. While in the rural areas the list is mostly categorized on lack of housing, meagre income and other deprivations, the urban list of PMJAY beneficiaries is drawn up on the basis of occupation.

Key Features of AB-PMJAY

• PM-JAY is a health assurance scheme that covers 10.74 crores households across India or approximately 50 crore Indians.
• It provides a cover of 5 lakh per family per year for medical treatment in empanelled hospitals, both public and private.
• It provides cashless and paperless service to its beneficiaries at the point of service, i.e., the hospital.
• E-cards are provided to the eligible beneficiaries based on the deprivation and occupational criteria of Socio-Economic Caste Census 2011 (SECC 2011).
• There is no restriction on family size, age or gender.
• All previous medical conditions are covered under the scheme.
• It covers 3 days of hospitalisation and 15 days of post hospitalisation, including diagnostic care and expenses on medicines.
• The scheme is portable and a beneficiary can avail medical treatment at any PM-JAY empanelled hospital outside their state and anywhere in the country.
• The Central government has decided to provide free testing and treatment of Coronavirus under the Ayushman Bharat Yojana.

Need for Ayushman Bharat for Senior Citizens

Ageing Population

• Demographic Shift:
  • India is currently benefiting from a demographic dividend. However, with a declining fertility rate and increasing life expectancy, India’s population is ageing.
  • In 2011, only 8.6% of the population was over 60 years old. This is projected to rise to 19.5% by 2050.
  • The absolute number of people over 60 is expected to almost triple from 103 million in 2011 to 319 million in 2050.
• Healthcare Expenditure:
  • An ageing population will lead to increased health and long-term care costs, labour shortages, public dissavings, and income insecurity in old age.
  • Senior citizens often bear the highest burden of chronic health conditions, leading to higher healthcare costs.

Low Insurance Coverage

• Coverage Statistics:
  • The India Ageing Report 2023 indicates that just over 20% of people over 60 are covered under health schemes like the Central Government Health Scheme and Employees State Insurance Scheme.
  • Coverage is slightly higher for elderly men (19.7%) compared to elderly women (16.9%), with no significant rural-urban divide.
• Reasons for Low Coverage:
  • Main reasons include low awareness (52.9%) and non-affordability (21.6%).

Diseases of the Elderly

• Health Challenges:
  • Elderly individuals are susceptible to chronic, non-communicable diseases and their complications.
  • They are also more vulnerable to infectious diseases due to a weakened immune system.

Analysis of Ayushman Bharat Expenditure

• Specialty Expenditure:
  • Government data indicates that the majority of funds under the scheme are spent on five key specialties: cardiology, general medicine, general surgery, orthopaedics, and medical and radiation oncology.
• Relevance to Elderly Population:
  • This expenditure pattern highlights that the government is already spending most of its healthcare budget on treatments predominantly required for the elderly population.

-Source: The Hindu