While welcoming the Centre’s move to expand coverage under Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) to all citizens aged 70 years or above, industry insiders pointed out that the sustainability of the scheme hinges on ensuring adequate reimbursement rates and timely payments to hospitals.
AB-PMJAY provides cashless and paperless benefit cover of Rs 5 lakh per annum per family on a floater basis in empanelled hospitals across India.
Under the expanded purview of the scheme, eligible senior citizens, who belong to families already covered under AB-PMJAY, will get an additional top-up cover up to Rs 5 lakh per year for themselves. All other eligible senior citizens, whose families are not covered under the scheme, will also get a cover up to Rs 5 lakh per year on a family basis.
Highlighting that the move would enable more families to access essential services without the burden of overwhelming medical expenses, Dr Harsh Mahajan, chair of FICCI Health Services Committee and founder, Mahajan Imaging and Labs pointed out that expanding the beneficiary base by such a significant margin would present challenges, particularly regarding the viability of the scheme for smaller and medium-sized hospitals.
“These institutions often operate on tight margins, and the added pressure of accommodating a larger patient base, especially with senior citizens requiring more intensive care, could strain their resources,” he added.
Commenting on the issues being faced, Dr Girdhar Gyani, Director General, Association of Healthcare Providers (AHPI) said that increasing the beneficiary base could bring additional considerations for the scheme’s operational dynamics.
“Ensuring that reimbursement rates are fair and that payments are processed in a timely manner will help support healthcare providers and facilitate smooth implementation through targeted support and streamlined financial processes will be key in ensuring these hospitals can continue to provide high-quality care while adapting to the broader scope of the scheme,” he added.
Experts pointed out that timely payments are critical as delays can disrupt cash flow and hinder the ability of these hospitals to maintain the quality of care.
“Without addressing these implementation challenges, there is a risk that the expansion could overwhelm the system, making it difficult for smaller providers to continue participating, ultimately affecting the availability and quality of healthcare services for the elderly,” Mahajan added.
Public health experts felt that as India is ageing, covering senior citizens under health cover is critical.
“India’s life expectancy at birth has increased continuously due to the decline in mortality and fertility. The mortality and fertility transition clearly indicate that the population ageing will be accelerated in near future. As per the latest United Nations estimates, India’s population aged 65 and above will increase from 104 million in 2024 to 246 million in 2050 and 416 million in 2075. The latest estimate of Government of India’s Sample Registration System for the years 2016-20 shows that the life expectancy of the Indians at birth is 70 years and at age 70 is 11.9 years. It means that the Indians who have already reached the age of 70 years will live additionally for 12 more years,” said Anjali Sane, Dean, School of Economics and Commerce, MIT World Peace University, Pune.
“Under such circumstances, the Government of India’s decision to cover the medical insurance for its senior citizens above the age of 70 is a welcoming decision. Not all the senior citizens in the country have the income capacity to purchase health insurance from the private sector. The decision will satisfy our long pending objective to achieve universal health coverage at least for our senior citizens,” she added.
Probal Ghoshal, chairman, director and co-founder, Ujala Cygnus Healthcare Services added that with the senior population in India growing rapidly, the move addresses the specific healthcare needs of the elderly.
“Many senior citizens require specialised, ongoing care, and by extending coverage under Ayushman Bharat, the government is ensuring that this demographic has access to vital treatments,” he added.
More geriatric packages in the offing
The Centre is targeting to include more geriatric packages in the Ayushman Bharat program, according to sources.
“Currently there are 25 elder care packages. The government is working to add more geriatric packages,” an official in the know said. The government will also come up with exclusive awareness programmes including IEC campaigns.
“Since AB-PMJAY scheme is an application-based scheme, people will need to register on the portal,” the official added. Sources indicate that a separate link will be provided for eligible senior citizens to enrol themselves in the scheme.
Sources in the Ministry of Health and Family Welfare added that the financial outlay of Rs 3,437 crore marked for expansion of coverage under Ayushman Bharat to all senior citizens aged 70 or above will be spread over one and a half years.
“The outlay is for the remaining six months of this financial year and the next full financial year,” an official said. Business Standard
