The Union Cabinet’s decision to expand the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) to citizens aged 70 and above has been celebrated as a move to address India’s growing elderly healthcare needs. Offering Rs 5 lakh in annual health insurance to over six crore senior citizens, this initiative promises to reduce the financial burden of healthcare for the elderly.

However, a closer look reveals several challenges that could undermine its effectiveness and sustainability. India’s elderly population is projected to reach 319 million by 2050, constituting nearly 20 per cent of the total population. With this demographic shift, there is an increasing need for long-term care, especially for chronic illnesses such as diabetes, arthritis, and heart disease. Unfortunately, India’s healthcare infrastructure remains illequipped to meet these needs, especially in rural areas where access to care is already limited.

A 2021 report from the Ministry of Health and Family Welfare showed that only 0.2 per cent of Indian hospitals have geriatric care units. This disconnect between insurance coverage and the actual availability of agespecific healthcare services raises concerns. Without investments in specialized healthcare infrastructure, the expanded insurance coverage under AB PM-JAY could result in overcrowded hospitals and substandard care for senior citizens. The extension of AB PM-JAY to all senior citizens, regardless of socio-economic status, signals an effort toward universal health coverage.

However, this inclusive approach may dilute the scheme’s intended impact on the most vulnerable groups. Wealthier senior citizens, many of whom already have access to private insurance or employer-provided benefits, will also benefit from this policy. A 2022 study by the Insurance Regulatory and Development Authority of India (IRDAI) found that over 12 per cent of the population, primarily in urban areas, has private health insurance. Including wealthier individuals could result in a misallocation of resources, diverting attention and funds from low-income senior citizens who rely on government support.

Additionally, beneficiaries of public schemes like the Central Government Health Scheme (CGHS) and Ex-Servicemen Contributory Health Scheme (ECHS) can opt into AB PMJAY, which introduces redundancy. Instead of covering those who already have insurance, the government should focus on closing gaps in access, ensuring that vulnerable populations receive priority. Expanding AB PM-JAY to include an additional six crore elderly beneficiaries will place a significant financial strain on India’s already overburdened public healthcare system.

India spends only 1.28 per cent of its GDP on public healthcare, one of the lowest rates globally, far below the recommended 5 per cent needed for universal coverage. A 2022 NITI Aayog report revealed that several Indian states, including Bihar and Uttar Pradesh, are already struggling to meet their healthcare obligations. Expanding AB PM-JAY without increasing public healthcare funding could result in states cutting costs, which may lead to poor-quality care, especially in economically weaker regions. The scheme’s sustainability is also contingent on the capacity of state governments to implement it. Wealthier states may manage the expansion, but poorer states could face disparities in healthcare quality and accessibility, exacerbating regional inequalities.

To meet the growing demand for healthcare services, the government is increasingly turning to public-private partnerships (PPPs). While private sector participation can augment healthcare capacity, it also presents risks. Private hospitals may exploit the system by inflating costs, as highlighted by a 2020 Comptroller and Auditor General (CAG) investigation into AB PM-JAY. Additionally, private insurers often categorize elderly patients as high-risk due to their chronic conditions, which could lead to denials of coverage or inadequate services. The expansion of AB PM-JAY must be accompanied by stringent regulatory oversight to prevent profiteering and ensure that private sector involvement does not undermine equitable access to care. Bureaucratic complexities often prevent citizens from fully accessing government welfare schemes, and AB PM-JAY is no exception.

A 2021 survey by the National Statistical Office found that only 7 per cent of rural households have internet access, limiting the ability of elderly citizens in rural areas to navigate digital processes for enrollment. The introduction of a distinct health card for senior citizens aims to simplify access to healthcare, but unless the government addresses structural issues such as digital literacy and geographical barriers, a significant portion of eligible citizens may remain excluded. Offline enrollment centers and mobile services are essential for reaching elderly populations in rural and underserved areas. India faces a severe shortage of healthcare professionals, a problem that could be exacerbated by the expansion of AB PM-JAY.

A 2022 World Bank report indicated that India has only 0.7 physicians per 1,000 people, well below the global average of 1.5. This shortage is especially pronounced in rural areas, where healthcare workers are scarce. Geriatric care, a key component of elderly healthcare, is still underdeveloped in India. There is a lack of specialized training in geriatric medicine, and medical institutions offering such programmes are few. Without a robust workforce of healthcare professionals trained in elderly care, the expansion of AB PM-JAY could overwhelm an already strained system.

Short-term solutions like telemedicine and mobile healthcare units can help, but long-term investment in medical education and workforce development is essential. The expansion of AB PM-JAY to senior citizens is an important step toward addressing the healthcare needs of India’s aging population. However, its success depends on more than just providing insurance coverage.

The government must address financial sustainability, workforce shortages, bureaucratic barriers, and the inefficiencies created by extending coverage to those who may not need it. By investing in healthcare infrastructure, expanding geriatric services, and improving the efficiency of resource allocation, the government can ensure that AB PM-JAY becomes a transformative policy rather than a symbolic gesture. Only by tackling these challenges head-on can India’s elderly truly benefit from universal healthcare.

(The writer is a policy analyst and columnist, and the author of The Essential: On Healthcare)