Good, but not enough: On the extended coverage of the Ayushman Bharat scheme

Extension of free health coverage to all over 70 years is good, but more needs to be done

In a welcome move, the Union government’s decision to extend the coverage of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) to senior citizens over 70 years, irrespective of their income, provides a modicum of free health coverage to nearly 60 million people. With out-of-pocket expenditure for health care in India among the highest in the world, the decision is indeed laudable. While the decision to provide free health coverage up to ₹0.5 million per year for a section of the population is noble, it will in no way fulfil the public health objectives that are much needed for the targeted beneficiaries. First and foremost, the health assurance scheme is limited to secondary and tertiary care hospitalisation. The absence of coverage for outpatient care, diagnostics and medicines is particularly concerning as chronic diseases have increased sharply in India in the last few decades. Increased life expectancy and an early onset of these diseases would mean that people over 70 may very often suffer from multiple chronic diseases. Most of the health-care expenditure by the elderly will, therefore, be through outpatient care (40%-80%), which will not be covered by the scheme. Since its launch in 2018, the penetration of PM-JAY into smaller cities and towns has been low in most States. Unlike in most of the southern States, primary and secondary health care in the public sector has been largely neglected and is inadequate and ill equipped to meet the demand in other parts. Robust primary and secondary public health care will sharply cut the load on tertiary health care and hence the need for curative care; a reduced curative care load at tertiary hospitals will make the PM-JAY scheme succeed.

Thailand focused and progressively strengthened its primary health-care system, and even diverted funds earmarked for urban hospitals to build rural hospitals and health centres to attain universal health coverage. In contrast, in the U.S., banking primarily on insurance-based schemes is what led to the surging costs of health care. India appears to be going the U.S. way. Though there is waning enthusiasm in the private sector due to low treatment rates and delayed payment, as per media reports, since its launch, two-thirds of the total money spent each year under the PM-JAY scheme went to private hospitals; it was 53% in the case of the southern States. Weakened primary and secondary health care will result in an overload in tertiary health care, which the private players will be well poised to take advantage of. This can lead to a further shrinking of the government’s commitment to strengthen the public health-care system by over-relying on the insurance modality which is neither affordable nor will provide appropriate health care for the needy. In its present form, PM-JAY is a measure that is essential, but is incomplete