Deepak Dwivedi
THE Union Cabinet’s decision to approve universalisation of health coverage under the Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) – to all Indians above 70 years of age is a welcome move.
At the launch of the BJP’s election manifesto earlier this year, PM Modi had announced that the Government was determined to include every senior citizen above 70 years of age in the PMJAY scheme. But since the Union Budget presented in July 2024 was silent on the issue, there were fears that the implementation of the expansion may get delayed. This massive expansion of the scheme, benefitting around 45 million families across India, has dispelled those fears.
The expansion of the AB-PMJAY to nonpoor households can be considered a first step of many to follow offering financial protection to the Indian middle class during health emergencies requiring hospitalisation care. In recent years, various media stories have appeared on plans to include 400 million non-poor citizens into the ABPMJAY fold, but no concrete decision had been announced until now. What the latest Cabinet decision has done is subsidise the premium for the most vulnerable within the non-poor population, which is a commendable step. The 70+ aged population has grown from 2.8 per cent of the population in 2001 to 4.3 per cent in 2021, and is expected to double by 2031.
Without insurance coverage, a substantial proportion of healthcare expenses of the older population in India is financed out of pocket, putting their families at risk of increased vulnerability to financial crises. As a recent Niti Aayog report notes, many among the elderly reach old age without sufficient savings or pensions to live on or to support their long-term care. It is estimated that almost 70 per cent of the elderly are dependent for everyday maintenance on family and relatives, putting economic pressure on households. By offering universal coverage to the 70+ population, the Government is trying to change the status quo.
The expansion is part of a series of policy initiatives addressing issues of the elderly population. A look at the usage data of ABPMJAY shows that the elderly population (60+) comprises 14 pc of the more than 350 million Ayushman card holders, who have accessed the scheme. At the same time, almost-one-fourth of all authorised hospital admissions, amounting to 69 million, under AB-PMJAY from its inception in 2018, were of patients aged 60 or above. In line with the inclusion criteria of AB-PMJAY till now, these patients were from poor and vulnerable households. With the current expansion into the non-poor households, these proportions are going to go up in the years to come, offering respite to millions of families.
The Government plans to implement the expansion soon, and the existing ABPMJAY structures will be used to roll out the scheme. However, concerns about its awareness among the neediest remains an issue that may aggravate with age. A study found that although over 70 per cent of households across India were aware of the PMJAY scheme, the awareness was lowest among households in the bottom two quintiles – precisely the population which needs the most assistance. Mass campaigns with the help of local governments are needed to reach every household with elderly members who are over 70 years of age.
