That the central government announced the extension of the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) to the elderly, or those above 70 years of age, to cover their medical expenses in the private sector is a welcome move. It was also much needed given the spiraling costs of medical care in the private sector, the unavailability or inaccessibility of quality care in public hospitals, and the lower income potential of the elderly. This, when read with the recent decision of the insurance regulator to remove the 65-years cap for health insurance, will hopefully make healthcare more affordable for the silver generation who comprise around 10% of the population or 104 million, or at least a section of them.
.jpg)
However, this move is not enough for three reasons. First, a large number of the elderly live in towns and villages where private healthcare or quality care in private hospitals is more absent than available which puts the policy into the charmed space of welfare promised on paper but not realized in reality. Second, this policy does not cover outpatient care, diagnostics and medicines which, by all accounts, are the major medical expenditures of senior citizens; depending on the state, 40-80% of expenses are on outpatient care, according to reports. From this perspective, by limiting to the secondary and tertiary care, the policy falls short of reaching where most needed. Third, by extending it to the elderly accessing the private sector which usually operates in the tertiary care or specialized hospitals, the scheme has further strengthened it; reports are that nearly 53% in the southern states but two-thirds in other states of the PM-JAY spends go to the private sector whose reach is mostly limited to cities.
A likely impact of these would be the further shrinking of the public healthcare systems across the country and the strengthening of the system that mimics the US model which stands broken. The shrinkage or withdrawal of the public sector from healthcare not only puts millions in peril, who earn too little to afford the private care but cannot rely on PM-JAY either because of its limitations, but also sets up Indians on a health trajectory that the country can ill afford. The way ahead is not merely to make private care affordable for a section of senior citizens but to build the public healthcare system to be a robust and reliable one that extends care to all.
