The government’s schemes with too many restrictions to make them truly inclusive by focusing only on the target groups often become utterly counterproductive. They not only yield halfhearted benefits to those covered but also exclude many deserving from their purview, which is why universal health, education, and public distribution through public expenditure are demanded. The governments, too, keep promising to work towards that goal with the introduction of partially universal schemes like the Food Security Act, free education up to certain levels, and public-funded health insurance, notwithstanding many incongruities and infirmities in such schemes.
The Centre has recently introduced one such scheme which prima facie appears to be a universal health coverage scheme for all those above 70 years of age. But the devil in the details unfolds the flaws of the scheme, Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) for senior citizens above 70, rolled out on 29 October 2024. This scheme is an extension of the PM-JAY launched in 2018 to benefit the bottom 40 per cent of the Indian poor and vulnerable population comprising 12 crore households. While the government gloats over its success seen in its coverage and assistance, with 8.20 crore hospitalizations since its inception till November 1, people are not very happy with the programme because of its non or inadequate coverage of all their health needs besides the indifference of many empaneled hospitals in accepting the PM-JAY. Whatever the claims to the contrary, the PMJAY could not bring any significant change in our poor, rather sick, healthcare system. Health services have become commercial and the burden on people keeps increasing with ever-rising health costs.
As per a NITI Aayog report, 7 per cent of the people, that is about 10 crore people, fall below the poverty line every year due to the high out-of pocket health expenditure they incur. The new sch – eme for senior citizens is going to be no better for them. It considers those above 70 as seniors whereas 60 is normally taken as the benchmark; the Senior Citizens Act 2007 defines a senior citizen to be one who attained 60 years of age or above. Some state governments give old age destitute pensions to persons even below sixty years. So, among other things, people are demanding the inclusion of persons aged 60 and above in this seniors’ health scheme of the government. Yes, this will involve additional expenditure to meet the additional numbers of people. The government of India has initially allocated (towards its 60 per cent share) Rs. 3,437 crore while states are supposed to meet the remaining 40 per cent of the total cost.
The number of households is expected to be 4.5 crore and the number of persons above 70 to be 6 crore. There are 14.9 crore people above 60 as of July 2022 in India as per the UN Population Fund’s Report, which means the number of persons between 60 and 70 would be 8.9 crore based on these data sets. For this additional coverage (of the people between 60 and 70) about 150 per cent of the additional expenditure that is Rs.5,100 crore for the current year’s six months and next year is required. That would not be a big burden for the Central government but would be a great relief to the 8.9 crore sexagenarians in the country. The expenditure is not going to be that big given the fact that a significant number of persons are not using the scheme due partly to lack of awareness of its existence. About 68 per cent of the targeted people are not aware of the scheme as per one study, although it doesn’t tally with the official estimates.
Also, there are those who are sufficiently rich and who though entitled are unlikely to utilize the scheme with so many inadequacies and the care providers’ reticence. The second demand relates to the major challenge the beneficiaries face: many empaneled hospitals are turning down eligible patients. Their agony is not difficult to understand when in an emergency the hospitals refuse admission. That may lead to delayed or no treatment resulting in the further deterioration of their health and resultant complications, at times fatal. So, the demand is to make it mandatory for listed hospitals to treat eligible patients without giving them any scope to refuse based on any plea like non reimbursement of their dues from the government.
The third demand relates to unnecessary paperwork, health cards and other evidence when senior citizens need immediate medical attention. It is, therefore, a genuine expectation of the people not to insist on any document other than the Aadhaar card. Aadhaar shows the age of the patient which is the only condition to become eligible under the scheme. Once Aadhaar is linked to the senior citizens’ health scheme the other details like previous hospital visits and the benefits already drawn can be checked through it whereby balance eligibility in the given year can be assessed.
There are two other flaws in the scheme that need review. First, the treatment is limited to the extent of only Rs.5 lac per annum per family. If there are more senior citizens above 70 years in one family (certainly there are more as per the government’s data which says the scheme will benefit 4.5 crore families and 6 crore individuals) the Rs.5 lac amount is to be apportioned among the members which may be not adequate for the senior citizens’ health care. Second, not every ailment is treated under the scheme; there is a list of diseases that are not covered. Of course, the government has promised to expand it to cover geriatric treatments because of the introduction of the senior citizens’ health scheme.
The scheme should be revamped in such a way as to cover all ailments and all health care needs of senior citizens in order to be efficacious, and so that it does not end up an eyewash. Not only should the government overhaul the senior citizens PM-JAY, but it should introspect on its duty as a welfare state to provide universal healthcare to all citizens of the country. The protection of life and personal liberty guaranteed under Article 21 of the Constitution cannot be ignored by a democratic government. It is the people’s right to demand quality health care for all and it is the duty of the government to do so in a holistic manner instead of limiting the quantum of benefits and to a very limited number of people.
(The writer is a development economist and commentator on economic and social affairs)