The Union Cabinet has given the green light to a healthcare cover of Rs 500,000 for all citizens above the age of 70 years under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY). The decision, announced on Wednesday, is set to provide relief to millions of people across India, benefiting around 45 million families. Union Information and Broadcasting Minister Ashwini Vaishnaw termed the move as a step towards creating an inclusive healthcare system.
“All citizens above the age of 70 years, irrespective of their socio-economic status, will be eligible to avail the benefits of AB PM-JAY,” a government statement said.
The announcement has sparked reactions from the healthcare and legal sectors. “Extending healthcare coverage to all citizens above the age of 70 years under Ayushman Bharat PM-JAY, irrespective of their socio-economic status, is a landmark decision in creating a more inclusive and equitable healthcare system in India,” said Amit Chhabra, Business Head – General Insurance, Policybazaar.com. He added, “This move will fill a critical gap in India’s healthcare ecosystem, ensuring that senior citizens, who currently account for 10.5% of the country’s population, are not left unsupported during their most vulnerable years.”
Jasmine Damkewala, Senior Partner at the Advocates’ Circle and Advocate-at-law of the Supreme Court of India, said the initiative is in line with the constitutional provisions. “This initiative is a commendable step towards universal health coverage, in line with Article 21 of the Constitution of India, which guarantees the right to life and health,” she said.
Can all people over 70 years of age benefit from this plan?
The government has clarified that all citizens above the age of 70 years belonging to families already covered under AB PM-JAY will be entitled to an additional cover of Rs 500,000 per year. This means that families can share this cover among their senior members.
Those benefiting from other public health insurance schemes such as the Central Government Health Scheme (CGHS), Ex-Servicemen Contributory Health Scheme (ECHS) or Central Armed Police Force Ayushman (CAPF) can either stick with their existing plan or opt for the new AB PM-JAY benefits. Additionally, senior citizens having private health insurance policies or the Employees State Insurance Scheme will also be eligible for this expanded coverage.
How is coverage shared within families?
Health coverage for families with more than one eligible senior citizen will be split. Ashwini Vaishnaw explained, “If there are two senior citizens (aged 70 years or above) in a family, the Rs 500,000 coverage will be shared between them. This is a big step towards ensuring social security for senior citizens, especially at a time when India is transitioning towards nuclear families.”
India’s ageing
While the Ayushman Bharat scheme has been geared towards universal healthcare, it is the first time that a specific age group has been given comprehensive coverage. With India’s ageing population projected to increase significantly in the coming decades, the need for accessible healthcare has become increasingly pressing.
India’s population aged 60 years and above is projected to increase from 8.6 per cent in 2011 to 19.5 per cent in 2050, according to the Longitudinal Study of Ageing in India (LASI). In absolute terms, the number of people aged 60 years and above is likely to triple from 103 million in 2011 to 319 million in 2050. However, health coverage for this age group remains low at around 20 per cent, according to the India Ageing Report 2023.
Concerns remain
So far, the public is reported to have benefited over Rs 1 trillion from the Ayushman Bharat healthcare initiative. However, despite large-scale implementation, certain challenges remain.
One of the biggest issues raised is the limited participation of leading private hospitals in the scheme. Many prominent hospitals such as Fortis Healthcare, Kailash, Max and Manipal Hospital are yet to sign up for the Ayushman Bharat scheme. This raises questions about the accessibility of the scheme, especially for those who need advanced medical care. While many public and private hospitals are accepting Ayushman cards, the absence of these top-tier hospitals is being felt.
“The reported delays in payment to private hospitals raise concerns about the implementation of the scheme and could contravene the provisions of the Clinical Establishments (Registration and Regulation) Act, 2010, which mandates timely payment for healthcare services,” Damkewala said. He suggested several measures to address this issue:
1. Ensure timely release of funds to states and hospitals as per National Health Mission (NHM) guidelines.
2. Streamline the payment process through robust IT infrastructure in line with the Digital India initiative and the Information Technology Act, 2000.
3. Establish an independent complaints redressal mechanism for hospitals as provided for in the Consumer Protection Act 2019.
4. Collaborate with private hospitals to address their concerns and find collaborative solutions.
“By taking these steps, the government can ensure that the benefits of Ayushman Bharat reach the intended beneficiaries without any hindrance and uphold the right to health as enshrined in Article 21 of the Constitution of India,” Damkewala added.
First published: September 12, 2024 | 17:20 IS
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