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Context: A Political party during the election campaign has announced to extend the Ayushman Bharat scheme to all senior citizens to address the healthcare needs of an ageing population.

About the Ayushman Bharat Scheme

• The Ayushman Bharat Yojana, also known as Pradhan Mantri Jan Arogya Yojana (PM-JAY), is a government-sponsored health insurance scheme aimed at providing affordable healthcare services to underprivileged families in India.
• It offers financial coverage of up to Rs. 5 lakh per year per family for secondary and tertiary care hospitalisation, both public and private.

Features of PM-JAY

• PM-JAY aims to cover approximately 10 crore households or 50 crore individuals across India.
• Cashless payment and paperless recordkeeping through the hospital or doctor's office.
• Criteria from the Socio-Economic and Caste Census (SECC) 2011 are used to determine eligibility for benefits.
• No restriction on family size, age, or gender.
• All pre-existing medical conditions are covered under the scheme.
• Covers 3 days of pre-hospitalization and 15 days of post-hospitalization expenses, including diagnostic care and medication.
• The scheme is portable, allowing beneficiaries to get medical treatment at any Ayushman-empanelled hospital outside their state and anywhere in the country.

Challenges Faced by PM-JAY ●Infrastructure Development: Implementation of a national healthcare scheme like PM-JAY requires significant infrastructure development, especially in states with existing healthcare challenges. ●Healthcare System Challenges: India faces challenges such as a shortage of doctors, the prevalence of infectious diseases, and relatively low central government investment in healthcare. ●Private Sector Participation: Many private corporate hospitals have not joined the program, citing challenges related to offering services at government-specified prices. ●Misuse and Fraud: There have been instances of misuse of the Ayushman Bharat scheme by private hospitals, including the submission of fake medical bills and fraudulent claims.

Impact and Benefits

• Increased Access to Healthcare: PM-JAY has significantly increased access to healthcare services, especially among economically disadvantaged populations who previously faced financial barriers to healthcare.
• Revenue Generation for Government Hospitals: Revenue of government hospitals has increased due to the scheme, leading to improved facilities and increased patient trust.
• Reduction in Out-of-Pocket Expenditure: The scheme has helped reduce out-of-pocket expenditures for medical treatments, preventing many families from falling into poverty due to healthcare expenses.
• Universal Healthcare Coverage: PM-JAY represents a step towards universal healthcare coverage in India, aiming to bridge the gap in healthcare access and affordability.

Ayushman Bharat Yojana addresses healthcare disparities and provides financial protection against medical expenses for vulnerable populations.  The need of the hour is to address issues related to infrastructure development, private sector participation, and prevention of misuse to ensure the scheme's long-term success in improving healthcare access and outcomes across India.

Significance of extending the Ayushman Bharat Scheme to all Senior Citizens

Universal Health Coverage for Seniors

• Equitable Access: The extension of Ayushman Bharat to all senior citizens ensures that this age group gains access to universal health coverage, a critical step towards reducing disparities in healthcare access among different segments of the population.
• Financial Protection: Senior citizens often face higher healthcare costs due to age-related illnesses and chronic conditions. Ayushman Bharat's coverage of up to Rs 5 lakh per family per year can provide substantial financial protection against expensive medical treatments and hospitalizations.

Addressing Aging Population Trends

• Demographic Shift: India's demographic profile is shifting towards an older population due to declining fertility rates and increasing life expectancy. By 2050, nearly 19.5% of India's population is projected to be over 60 years old. Extending healthcare coverage to seniors is crucial to meet the healthcare needs of this growing demographic.

Health Challenges Faced by Seniors

• Chronic Diseases: Senior citizens are more susceptible to chronic and non-communicable diseases such as cardiovascular diseases, diabetes, hypertension, and musculoskeletal disorders. The extended coverage under Ayushman Bharat can help mitigate the financial burden associated with managing these conditions.
• Infectious Diseases: Ageing populations are also more vulnerable to infectious diseases due to weakened immune systems. Comprehensive health insurance coverage can facilitate timely access to healthcare services for the prevention and treatment of infectious diseases.

Reduction in Out-of-Pocket Expenditure

• Financial Relief: The cost of healthcare can be a significant financial burden for seniors, especially those relying on fixed incomes. Ayushman Bharat's expansion can substantially reduce out-of-pocket medical expenditure for senior citizens by covering a wide range of healthcare services and treatments.
• Impact on Household Budgets: Lower out-of-pocket expenditure means less financial strain on elderly individuals and their families, contributing to improved financial stability and overall well-being.

Role in Healthcare Delivery

• Focused Specialties: Ayushman Bharat's focus on key specialities like cardiology, general medicine, orthopaedics, and oncology aligns with the prevalent healthcare needs of senior citizens. This ensures that essential medical treatments and procedures are covered under the scheme.
• Government Support: By reducing the financial burden on individuals and families, Ayushman Bharat supports the government's efforts to enhance access to quality healthcare services across the country, particularly for vulnerable populations like senior citizens.

Potential Challenges and Implementation

• Awareness and Outreach: Ensuring that all eligible senior citizens are aware of and able to enrol in Ayushman Bharat will require robust outreach and awareness campaigns, especially in rural and underserved areas.
• Healthcare Infrastructure: The successful implementation of the extended scheme will necessitate strengthening healthcare infrastructure, including hospitals and clinics, to accommodate the increased demand for services.

Conclusion

• Extending Ayushman Bharat to all senior citizens represents a significant step towards achieving universal health coverage in India and addressing the evolving healthcare needs of an ageing population. By reducing financial barriers to healthcare access, the scheme can contribute to improved health outcomes and well-being for senior citizens across the country. However, effective implementation and targeted outreach will be critical to maximising the impact of this initiative.

Must Read Articles:

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

Source:

Indian Express

Wikipedia

PRACTICE QUESTION Q. With limited resources, a universal healthcare system might face challenges in prioritising treatments and allocating resources fairly. How can ethical guidelines be established to ensure patients receive necessary care while also considering factors like cost-effectiveness and resource constraints?