Ayushman Bharat Health Insurance Scheme

Context

Recently, the Bharatiya Janata Party (BJP) in its Election Manifesto for the 2024 Lok Sabha Election promised for expansion of Ayushman Bharat health Insurance Scheme to All Senior Citizens.

Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY)

• It is a Centrally Sponsored Scheme under the Ministry of Health and Family Welfare (MoHFW).
• It is an umbrella scheme of two major health initiatives, namely 
  • Health and Wellness Centers (Ayushman Arogya Mandir)
    • These centers provide comprehensive health care, including for non-communicable diseases and maternal and child health services. 
  • National Health Protection Mission (AB-PMJAY):
    • It provides a defined benefit cover of Rs. 5 lakh per family per year. 
    • This cover will take care of almost all secondary care and most of tertiary care procedures. To ensure that nobody is left out (especially women, children and elderly) there will be no cap on family size and age in the scheme. 
    • The benefit cover will include pre and post-hospitalisation expenses. 
    • All pre-existing conditions will be covered from day one of the policy.
    • A defined transport allowance per hospitalization will be paid to the beneficiary.
    • Beneficiaries:
      • The families covered under this scheme have been included on the basis of occupational criteria of Socio-Economic Caste Census 2011 (SECC 2011). 
      • PM-JAY also included the beneficiaries of the then existing Rashtriya Swasthya Bima Yojana, which were not present in the SECC 2011 database.
• Objective:
  • To alleviate the burden of out-of-pocket expenditure on the impoverished. 
  • To provide the poor with access to critical medical treatments and emergency care that were previously financially unattainable.
  • It aims to achieve universal health coverage.

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Reasons for Inclusion of All Senior Citizen under Ayushman Bharat health Insurance Scheme

• Ageing Population: According to the Longitudinal Ageing Study in India (LASI), the population over the age of 60 years will nearly triple from 103 million (8.6%  of total population) in 2011 to 319 million i.e. expected to increase to 19.5% of total country’s population in 2050. 
• Low Insurance Cover: According to the India Ageing Report 2023, Insurance coverage Just over 20% of people over the age of 60 years are covered under health schemes.
• Health challenges: The elderly are not only affected by chronic, non-communicable diseases and their complications, they are also more prone to infectious diseases because of a weakened immune system. 
• Out-of-Pocket Expenditure: The out-of-pocket health expenditures account for more than 70% of health expenditures in India, leading to health vulnerabilities in the older population.

Significance of Expansion of Ayushman Bharat Health Insurance Scheme to All Senior Citizens

• Healthcare Accessibility: Extending insurance coverage to all senior citizens promotes overall well-being and quality of life by enhancing accessibility to healthcare services. 
• Financial Security & Economic Impact: It will help in reducing the financial burden of healthcare expenses as it covers costs associated with medical treatments, prescription drugs, and hospitalization.
• Social Inclusivity: It will ensure equality and dignity among the elderly population to actively participate in societal activities without worrying about healthcare expenses regardless of financial status. 
• Reducing the Burden on Public Health Care Institutions: It will contribute to more efficient allocation of healthcare resources and improved healthcare delivery for all segments of the Society.