DC Edit | Benefits for 70+ welcome; resolve healthcare hiccups

From the looks of it, it is one of the most welcome decisions of the Union government under Prime Minister Narendra Modi. Extending the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) scheme to cover all persons aged 70 and above will benefit six crore Indians in 4.5 crore homes. The scheme envisages covering treatment expenses of the insured up to Rs 5 lakh a year in government as well as private healthcare facilities. As per the extended scheme, all the eligible persons will be issued Ayushman Vaya Vandana cards with which they can avail coverage irrespective of their financial status or income.

For the Prime Minister, the decision will help the government meet one of the BJP’s most important election promises made this year not so long ago. It is an important milestone. What’s more, this could be the first such universal healthcare insurance scheme anywhere in the world offered to every citizen meeting the minimum criterion.

The AB-PMJAY is an improved reincarnation of the Rashtriya Swasthya Bima Yojana (RSBY) which provided health insurance coverage for Below Poverty Line (BPL) families, launched in 2008 by the United Progressive Alliance government. The Union government met 75 per cent of the estimated annual premium of Rs 750 while the state governments contributed the rest. About 3.4 crore smart cards were issued under the scheme, which later tapered off owing to mounting bills and inadequate funds allocation.

Under the AM-PMJAY, launched in 2018, the Union government would meet 60 per cent of the expenditure while the states will bear 40 per cent. As per government claims, 30 crore Ayushman cards have been issued till January 2024 to 12 crore beneficiary families which catered to 6.2 crore hospital admissions worth more than Rs 79,157 crores. This has saved poor and deprived families more than 1.25 lakh crores in terms of out-of-pocket expenditure or so goes the official statement.

It may be noted that the scheme underwent several hiccups. The government had earmarked Rs 7,200 crores for the scheme in 2023-24, which was grossly inadequate. Reports have suggested that several hospitals in the private sector have indicated their unwillingness to cooperate with the scheme due to delay in payments though the government claims that it has settled 77 per cent of the claims as of 2024.

There were adverse remarks by the Comptroller and Auditor-General of India which pointed to potential fraud as lakhs of cards were linked to a single telephone number and several thousand cards were connected to a single Aadhaar number.

While extending the scheme, the government must take extra care to ensure that the elderly are treated with the care they deserve. The processes must be made easier for them and the payments to the hospital should be prompt.

While such schemes may offer the poor and needy immediate succour, the long-term plan should be that the government strengthen the healthcare infrastructure in the country. In a country where about 80 crore people survive on grains supplied by the government, it will be unwise to assume that insurance schemes will be the best way to address their healthcare requirements. There are no easy solutions to the fundamental needs of a large country such as ours.