The Centre is exploring a dozen different models to extend the benefits of its marquee free healthcare insurance scheme-Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY)-to senior citizens, according to two officials with knowledge of the development.
The move is in keeping with a promise made by the ruling NDA (national democratic alliance) in the run-up to the general elections to cover all people 70 years of age and above in the PM-JAY.
“Different models are being studied by the government to implement AB PM-JAY for senior citizens 70 years of age and above,” said the first official cited above, adding that the government is working out the mechanics of how to extend the scheme.
The National Health Authority (NHA), which has been tasked with formulating the plan, is actively looking at two preferred models among the several being considered.
“Two models are being studied to take the initiative forward-all family members with senior citizens may get covered, or only senior citizens in a particular family will get the health coverage,” said the second official cited above.
Accordingly, health benefit packages are being firmed up for geriatric treatment, with hospitals providing dedicated geriatric services to be onboarded for PM-JAY. Geriatric therapy is a medical specialty focused on the care of the elderly.
“The budget proposal has been submitted with a view to increase the beneficiary base of AB PM-JAY,” said the second official. “It is likely that the government may mention the implementation of PM-JAY for eligible senior citizens during the Union budget. Government meetings are being done internally to explore the mechanism and how to start with it.”
During the release of Bharatiya Janata Party’s (BJP’s) election manifesto, Prime Minister Narendra Modi had announced that all senior citizens above 70 years will be covered under the PM-JAY scheme, across poor families, middle income groups and even economically well-to-do families.
“Extension of PM-JAY’s coverage to the elderly will help prevent families from exercising painful choices between needed healthcare for elderly family members and other essential household expenditures,” said K. Srinath Reddy, former president of Public Health Foundation of India (PHFI).
“It will also enable elderly persons to be fit and functional, reduce their dependency, and make further economic and social contributions to society. This measure will promote social harmony,” he added.
According to the government’s population projection report 2011-2036, there are nearly 104 million elderly persons in India, of which 53 million are women and 51 million men.
With the new policy that is in the works, there may be a possiinter-generational mobility that having a senior member in a family will be a criterion to be eligible for the scheme regardless of whether they are listed in socio-economic caste census 2011 (SECC 2011) database or not. The scheme originally picked beneficiaries from this database.
This may also give an opportunity to non-poor families to benefit from the scheme. Another likely challenge that the government may face in implementing all families having senior citizens is “adverse selection”, which means all intended beneficiaries can immediately avail treatment under the scheme, even for pre-conditions, without any waiting period.
In the insurance industry, adverse selection refers to situations in which an insurance company extends insurance coverage to an applicant whose actual risk is substantially higher than the risk known by the insurance company.
Health benefit packages are being looked into for geriatric treatment as per the need of the elderly population. Meanwhile, hospitals providing dedicated geriatric services will be taken on board to offer PM-JAY services. This includes both state owned and private hospitals.
The scheme’s utilization could also increase premiums, which may lead to higher outflow for the government.
“Universal health coverage for people over 70 is an attractive concept, but the actual delivery of healthcare will be logistically complex and has many hurdles to overcome,” said Dr Rajeev Jayadevan, a leading public health expert, adding that by default, the group has a higher burden of disease and medical expenses. (Source: Mint)
