By Dr. Gyan Pathak
Prime Minister Narendra Modi led government has a penchant for launching exaggeratingly “exciting and impressive” scheme, but many of them only skin deep, ignoring the real issues facing the people of India. The latest cabinet decision on September 11, 2024 relating to health coverage of old people above 70 years of age is a glaring example. When the old people really needed “complete health coverage” the Centre approved only a “health insurance coverage” to all above 70 of only Rs5 lakh, merely a lollipot to sweeten the mouth for votes.
The scheme will be implemented under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY), as the government press release read. It said that AB PM-JAY is the world’s largest publicly funded “health assurance scheme”. However, the same press release starts with a false phrase “health coverage” which it is not. The press release read, “The Union Cabinet, chaired by the Prime Minister Shri Narendra Modi, has approved the health coverage to all the senior citizens aged 70 years and above irrespective of income.”
It should further be noted that the “health assurance scheme” called AB PM-JAY comes into operation only after a patient is hospitalised. It means a very large number of patients in majority who suffers from illness, though not got themselves hospitalized for whatsoever reason including lack of hospital beds, doctors, nurses, medicines, and equipment such as stretcher, are still out of health coverage.
Then what is the meaning of “health coverage” the phrase the government is using? It is just a deception, and people of the country will never know it if they do not have first-hand experience of going to hospitals and running pillar to post to get appropriate access to health facilities. You may have Ayushman Bharat cards, but getting health insurance facilities have never so easy, as it is advertised under propaganda. Government already had reported large scale corruption in Ayushman Bharat scheme in the past, which is in the documents submitted in the Parliament of India.
The present approval by the Central cabinet for the new scheme shows that the Centre has no plan of providing “complete health coverage” to the citizens of India in the near future to people of any age group. Complete health coverage would require all facilities in hospitals including doctors, nurses, medicines, and medical equipment etc. To provide complete health coverage under the Ministry of Health Modi government will have to accept right to health as a fundamental right.
Since Modi government does not want to bear the burden of the “complete health coverage” under the Ministry of Health, it had long back in 2018 devised “health assurance scheme” under the Ministry of Finance. One can understand the difference between the two as to what the change of ministries means.
Nevertheless, though fell short of the requirement of the senior citizens of India above 70 years, the approved scheme is significant, at least for those who will need hospitalisation. This aims to benefit approximately 4.5 Crore families with six (6) crore senior citizens with 5 Lakh rupees free health insurance cover on a family basis, the government said. The phrase “on a family basis” is still vague and needs clarification. If the government’s press release is of any indication, not every person over the ages of 70 in a family, age going to get this benefit.
Government said that the eligible senior citizens would be issued a new distinct card under AB PM-JAY. The senior citizens of the age 70 years and above belonging to families already covered under AB PM-JAY will get an additional top-up cover uptoRs5 lakh per year for themselves (which they do not have to share with the other members of the family who are below the age of 70 years). It is not clear what would be the status of “an additional top-up cover” if there are other members in the family over the age of 70 years?
With this approval, all senior citizens of the age 70 years and above irrespective of their socio- economic status would be eligible to avail the benefits of AB PM-JAY. It is theoretically a good thing, but unless it is implemented wisely, it may not benefit all the old persons in the country, though government has promised. The Scheme has clear lacunae since it talks about “per family”, “an additional card”, “don’t have to share with other family members below the age of 70”.
It means if the card is sharable among several members of a family over the age of 70 years, the insurance benefit will be clearly divided and diminished. It is common experience that majority of the families having older people in their home remain 2 or more for decades. Other problems are likely to crop-up at the time of implementation of the scheme on the ground.
Senior citizens of the age 70 years and above who are already availing benefits of other public health insurance schemes such as Central Government Health Scheme (CGHS), Ex-Servicemen Contributory Health Scheme (ECHS), Ayushman Central Armed Police Force (CAPF) may either choose their existing scheme or opt for AB PMJAY. It has been clarified that senior citizens of 70 years and above who are under private health insurance policies or Employees’ State Insurance scheme will be eligible to avail benefits under AB PM-JAY.
Centre has said that AB PM-JAY is the world’s largest publicly funded health assurance scheme which provides health cover of Rs. 5 lakh per family per year for secondary and tertiary care hospitalization to 55 crore individuals corresponding to 12.34 crore families. All members of the eligible families irrespective of age are covered under the scheme. The scheme has covered 7.37 Crore hospital admissions including 49 percent women beneficiaries. The public has benefited to the extent of over Rs. 1 Lakh crore under the scheme so far.
The expansion of cover to senior citizens of the age of 70 years and above was earlier announced by Hon’ble Prime Minister Shri Narendra Modi in April 2024.
The AB PM-JAY scheme has witnessed continuous expansion of the beneficiary base. Initially, 10.74 crore poor and vulnerable families comprising the bottom 40% of India’s population were covered under the scheme. Later, the Government of India, in January 2022 revised the beneficiary base under AB PM-JAY from 10.74 crore to 12 crore families considering India’s decadal population growth of 11.7 % over 2011 population. The scheme was further expanded to cover 37 lakh ASHAs/AWWs/AWHs working across the country and their families for free healthcare benefits.
Modi government should extend the scheme to at least all citizens above 60 years of age for now if not possible to extend it to all age group presently. The criterion of per family per year basis should be done away with. Moreover, in place of “health assurance coverage” of only Rs5 lakh that too for those who need hospitalisation, the government must think of “complete health coverage” for patients including the outdoors ones who are in majority but do not get any help to meet their medical expenses. (IPA Service)
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