Health cover for seniors, a welcome move

The Union Government’s announcement regarding coverage of all citizens above 70 years under the Ayushman Bharat Pradhan Mantri Arogya Yojana (AB PM-JAY) takes India a bit closer to the dream of universal health cover. The initiative is welcome and fulfils a key promise made by the Bharatiya Janata Party (BJP) in its 2024 election manifesto. Health security being among the topmost priority for citizens after food, the scheme is likely to be welcomed by all sections of people who face vulnerabilities on the front what with health insurance coverage being low, hovering just around 27 per cent.

Under the scheme Rs. 5 lakh free health insurance cover would be provided to nearly 6 crore people in 4.5 crore families and will benefit senior citizens regardless of their economic status. It will entail an expenditure of Rs. 3,437 crore in the first year and can be availed of by even those who are covered under private health insurance schemes or Employees State Insurance (ESI). However, those covered under the Central Govt Health Scheme (CGHS) will have the option to choose either the CGHS or the new scheme. However, the scheme suffers from some limitations as it provides cover for only secondary and tertiary healthcare and leaves out Out-Patient care, diagnostics, and medicines. Surveys reveal that 40 to 80 per cent of the seniors require OPD care.

With healthcare in rural areas and smaller towns suffering from negligence, the tertiary care centres in cities take the load. This calls for penetration of AB PM-JAY being made effective in villages and towns. Secondly, if the scheme has to succeed, efficiency need to be ensured in matters of clearing the payment to empanelled hospitals. Due to delayed and hassled payment, the private hospitals lack enthusiasm to entertain patients covered under the scheme.