Ayushman Bharat For Senior Citizens explained for UPSC Why In News ? The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) has been expanded to cover all Indians aged 70 years and older, regardless of their income.
  1. This expansion, approved by the Union Cabinet, marks a significant milestone in India's healthcare policy.
  2. Registration for the expanded scheme is expected to start within a week, with a formal launch likely by the Prime Minister.
ABOUT THE SCHEME The Ayushman Bharat programme was launched in 2018 to address health issues at all levels – primary, secondary, and tertiary. It has

two components:

  • Pradhan Mantri Jan Arogya Yojana (PM-JAY), earlier known as the National Health Protection Scheme (NHPS)
  • Health and Wellness Centres (HWCs)
Ayushman Bharat is an integrated approach comprising health insurance and primary, secondary and tertiary healthcare. Targeted Beneficiaries: 12 Crore Households.

ABOUT AB-JAY

Introduction:

  • Launch Date: September 2018
  • Objective: Provide secondary and tertiary healthcare services to vulnerable populations.

Features:

  • Coverage: Up to ₹5 lakh per family per year for hospitalization.
  • Target Audience: Poor and vulnerable families, covering around 40% of the population.
  • Eligibility: Includes 10.74 crore families based on Socio-Economic Caste Census (SECC) data.

Benefits:

  • Cashless Services: Beneficiaries get cashless access to healthcare services.
  • Health Benefit Packages: Includes surgeries, medical treatments, day care treatments, medicines, and diagnostics.

Implementation:

  • National Health Authority (NHA): Responsible for strategy, technological infrastructure, and National Digital Health Mission.
  • State Health Agencies (SHAs): Implement the scheme at the state level.
ABOUT HEALTH & WELLNESS CENTRES (HWCs) HWCs are being created by converting the existing primary health centres and sub centres. They provide comprehensive primary health care (CPHC) including a child and maternal health services, non-communicable diseases, and also diagnostic services, and free essential drugs. HWCs are important because they offer CPHC that is critical to enhancing health outcomes. Primary healthcare plays a vital role in preventing many disease conditions. Providing CPHC decreases morbidity and mortality at a lower cost and greatly reduces the requirement for secondary and tertiary care.

THE CURRENT EXPANSION

Registration Process
  • Eligibility: Individuals who have turned 70 as per their Aadhaar can register for the new health cover.
  • Registration Methods:
    • Through the Ayushman Bharat App
    • At the Ayushman Bharat counter at any government health facility
  • Features:
    • No exclusions or waiting period for pre-existing conditions.
    • Registration will include eKYC, with face-authorisation to assist elderly individuals whose fingerprints may be difficult to read.

Coverage Details :

  • Annual Cover: ₹5 lakh per elderly individual, shared within the family.
    • Example: If 2 elderly members are in a household, the ₹5 lakh cover is split between them.
  • Top-Up Cover: Elderly members of already covered families will receive an additional ₹5 lakh top-up, exclusive to elderly care. They will need to re-register to access this top-up.

Beneficiary Statistics :

  • Total Coverage: The scheme will cover approximately 6 crore individuals from 4.5 crore families.
    • Out of these, 1.78 crore are already covered.

Existing Health Schemes :

  • Coverage Options:
    • Integration with Other Schemes: Beneficiaries with other public health insurance (e.g., CGHS, ECHS) can either continue their existing schemes or opt for the expanded AB-PMJAY coverage.
    • New Health Cards: Senior citizens will receive new health cards for streamlined access to benefits.
    • Private Insurance: Individuals with private insurance can also avail of the Ayushman Bharat cover.
Financial Implications
  • Government Cost: The initial cost for expanding the scheme is ₹3,437 crore, covering six months of the current financial year and the entire next year. States will contribute 40% to the scheme’s cost.

SIGNIFICANCE OF THIS EXPANSION

  • Demographic Shift:
    • As of the 2011 census, 8.6% of India’s population was over 60.
    • By 2050, this is expected to rise to 19.5%, with 319 million people over 60.
    • The elderly are more likely to require hospitalization, with a higher admission rate compared to younger populations.
  • Current Coverage:
    • Only about 20% of the elderly population is covered by any health scheme.
    • Women constitute a larger share of the elderly population, with 58% being women and 54% of them widows. The scheme is expected to provide significant support, especially for widowed women.