Rising Costs for Senior Citizens Under Ayushman Bharat | 10 Aug 2024

Source: IE

Why in News?

Recently, the Union Ministry of Health and Family Welfare released data highlighting significant trends in the Ayushman Bharat Health Insurance Scheme (PM-JAY). This information underscores the increasing financial burden of providing healthcare to the elderly, particularly those aged 70 years and above.

What are the Key Takeaways Regarding Ayushman Bharat?

• Significant Elderly Admissions: The data reveals that out of nearly 6.2 crore approved hospital admissions until January 2024, 57.5 lakh were senior citizens aged 70 years and above. Government expenditure on treatments under the scheme totaled Rs 79,200 crore over the past six years, with approximately Rs 9,900(14%) crore allocated specifically for treating individuals aged 70 and over.
  
  • Elderly patients often require more intensive and costly treatments due to chronic conditions and multiple comorbidities, complicates treatment, increasing the likelihood of costly intensive care unit (ICU) care and extended hospital stays.
• State Variability: The proportion of elderly admissions varied widely among states, with Maharashtra (20.49%) and Kerala (18.75%) having the highest rates, while Tamil Nadu (3.12%) had the lowest.
  
  • Despite lower admission rates in Tamil Nadu, the cost of treatment per elderly patient remains high.
  • Only four states/UT — Goa, Ladakh, Lakshadweep, and Jharkhand showed a higher proportion of hospital admissions for older individuals compared to the total money spent on them.
• Concerns:
  
  • According to the Longitudinal Ageing Study in India (LASI), India's population over the age of 60 years is estimated to increase from 8.6% in 2011 to 19.5% by 2050, with the absolute number tripling from 103 million in 2011 to 319 million in 2050.
  • The government's plan to expand Ayushman Bharat aims to include all individuals over 70 years, regardless of economic status. This expansion could add nearly 4 crore new beneficiaries to the programme.
    
    • The current allocation of Rs 7,300 crore for the scheme, with only a Rs 100 crore increase from the previous budget, raises concerns about the adequacy of funding for such an expansion.
  • As healthcare costs for the elderly continue to rise, the scheme's sustainability and its ability to provide comprehensive coverage to all senior citizens will be a critical area of focus for policymakers.
    
    • Health-seeking behaviour is more prevalent among older, relatively affluent individuals, leading to a higher likelihood of policy utilisation and increased costs.
  • Experts warn that the cost of covering this demographic is likely to be higher than covering the poorest 40% across all age groups.

What are the Key Highlights About Ayushman Bharat Scheme?

• About: Ayushman Bharat, launched as a flagship scheme of the Government of India, is a significant step towards achieving Universal Health Coverage (UHC). Recommended by the National Health Policy of 2017, this scheme aims to meet the Sustainable Development Goals (SDGs), particularly the commitment to "leave no one behind."
• Key Components: Ayushman Bharat is structured around two interrelated components that work together to provide a seamless flow of care:
  
  • Health and Wellness Centres (HWCs): Announced in 2018, the creation of 1,50,000 HWCs aims to transform existing Sub Centres and Primary Health Centres, delivering Comprehensive Primary Health Care including maternal and child health, non-communicable diseases, and free essential drugs and diagnostic services.
  • Pradhan Mantri Jan Arogya Yojana (PM-JAY): It is the world's largest health assurance scheme, providing Rs. 5 lakh coverage per family per year for secondary and tertiary care hospitalisation, targeting over 12 crore poor and vulnerable families, covering approximately 55 crore beneficiaries, based on the Socio-Economic Caste Census 2011 (SECC 2011).
    
    • PM-JAY subsumed the Rashtriya Swasthya Bima Yojana (RSBY) and the Senior Citizen Health Insurance Scheme (SCHIS), expanding its reach and impact.
• Implementation: The Ayushman Bharat National Health Protection Mission Agency (AB-NHPMA) manages the scheme at the national level.
  
  • States and UTs are advised to implement the scheme through a dedicated State Health Agency (SHA), which can operate through an insurance company, a trust/society, or an integrated model.
• Impact: The scheme is expected to significantly reduce Out-of-Pocket Expenditure for healthcare by covering nearly 40% of the population, including secondary and tertiary hospitalizations.
  
  • With coverage up to Rs. 5 lakh per family, the scheme ensures access to quality healthcare, leading to improved health outcomes.

Way Forward

• Targeted Interventions: Develop specialised packages addressing common geriatric conditions to optimise resource allocation. Emphasise preventive healthcare and early intervention to reduce the severity of illnesses among the elderly.
• Financial Sustainability: Increased budgetary allocation for Ayushman Bharat, especially for geriatric care. Explore public-private partnerships to share the financial burden.
• Focus on Preventive Healthcare: Implement preventive healthcare measures targeting chronic conditions, ultimately lowering overall healthcare costs.
  
  • Promote community health programs that encourage regular check-ups and early detection of health issues, especially in rural areas where access to healthcare is limited.