Context: The extension of the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) to citizens above the age of 70 marks a crucial step toward universalizing healthcare in India. With the increasing elderly population, the extension of free healthcare coverage is a welcome move. However, challenges around access, coverage, and quality of care remain.
Relevance: General Studies Paper II – Governance, Welfare Schemes
Mains Question: Critically evaluate the decision to extend the AB-PMJAY to senior citizens over 70 years. Discuss the limitations of the scheme and suggest measures to improve its effectiveness.
- Overview of the Extension:
- The government’s decision to extend the AB-PMJAY to cover citizens over 70 years, irrespective of their income, aims to provide health insurance coverage to nearly 60 million people. The scheme offers free health coverage of ₹5 lakh per annum per family.
- With only 20% of the elderly currently covered by safety nets like the CGHS and other employer-funded schemes, this expansion is a significant step toward supporting an aging population.
- Impact on Healthcare Costs:
- Out-of-Pocket Expenditure (OOPE) for healthcare in India is among the highest in the world, accounting for 50% of all health expenses, which often leads to poverty.
- The AB-PMJAY has successfully covered 7.37 crore hospital admissions since its inception in 2018. However, OOPE continues to affect a large portion of the population due to the scheme’s limitations, primarily its focus on secondary and tertiary hospitalizations while excluding outpatient care, diagnostics, and chronic disease management.
- Challenges of Accessibility and Service Quality:
- While the expansion of AB-PMJAY is beneficial, there are concerns about uneven access. Reports have indicated issues where doctors in government hospitals bypassed the scheme, leaving families to face administrative burdens and financial distress.
- The Niti Aayog’s report recognizes the lack of family-centered primary healthcare as a growing issue. The over-reliance on tertiary care hospitals exacerbates the problem by increasing the load on these institutions, leading to inefficiencies and care delays.
- Primary and Secondary Care Gaps:
- The scheme’s lack of coverage for outpatient care is particularly concerning, as 40%-80% of healthcare expenditure for senior citizens will involve outpatient services, especially due to the prevalence of chronic diseases in the elderly.
- Countries like Thailand have strengthened their primary healthcare systems to reduce the burden on tertiary care, ensuring more comprehensive and cost-effective healthcare delivery. In contrast, India’s growing reliance on private hospitals for tertiary care under AB-PMJAY risks neglecting the primary and secondary public healthcare systems, which are often underfunded and ill-equipped.
- Private vs Public Sector Involvement:
- The scheme has seen a disproportionate allocation of funds to private hospitals, with over two-thirds of the funds going to private institutions. This further marginalizes the already struggling public healthcare system, especially in non-southern states, where the penetration of AB-PMJAY into smaller cities remains low.
- Without substantial investments in public health infrastructure, the scheme risks deepening inequalities and perpetuating gaps in service quality.
Additional Data:
- 7.37 crore hospital admissions under AB-PMJAY since 2018.
- 50% of healthcare expenses in India are borne out-of-pocket, highlighting the need for comprehensive health coverage.
Conclusion:
The extension of AB-PMJAY to cover citizens over the age of 70 is a positive move toward universal healthcare. However, its limited focus on hospitalizations, coupled with challenges in access and service delivery, undermines its potential impact. Strengthening primary and secondary healthcare, expanding coverage for outpatient care, and improving the efficiency of public health infrastructure are essential to make the scheme more effective for the elderly population.
