Finance Minister Nirmala Sitharaman is all set to present the full budget for FY25 in the third week of July. As per Mint, this budget is likley to focus on senior citizens' health, as the centre is exploring a dozen different models to extend the benefits of its marquee free healthcare insurance scheme—Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY).
“Different models are being studied by the government to implement AB PM-JAY for senior citizens 70 years of age and above," a person with the knowledge of the matter told Mint.
Notably, the ruling NDA in the run-up to the general elections had promised to cover all people above 70 years in the PM-JAY. As per Mint, the Centre is also working out the mechanics of how to extend the scheme. The National Health Authority (NHA), which has been tasked with formulating the plan, is actively looking at two preferred models among the several being considered.
“Two models are being studied to take the initiative forward—all family members with senior citizens may get covered, or only senior citizens in a particular family will get the health coverage," another person with knowlege of the matter told Mint.
The Mint report further mentioned that health benefit packages are being firmed up for geriatric treatment, with hospitals providing dedicated geriatric services to be onboarded for PM-JAY.
“The budget proposal has been submitted with a view to increase the beneficiary base of AB PM-JAY," said the second official. It is likely that the government may mention the implementation of PM-JAY for eligible senior citizens during the Union budget. Government meetings are being done internally to explore the mechanism and how to start with it", the person told Mint.
As per Government's population projection report 2011-2036, there are nearly 104 million elderly persons in India, of which 53 million are women and 51 million men. If this new policy is implemented there is a possibility that having a senior member in a family will be a criterion to be eligible for the scheme regardless of whether they are listed in socio-economic caste census 2011 (SECC 2011) database or not. By this non-poor families might also be benefitted from the scheme.
Another possible challenge is “adverse selection" which means, all intended beneficiaries can immediately avail treatment under the scheme, even for pre-conditions, without any waiting period. However, in the insurance industry, adverse selection refers to situations in which an insurance company extends insurance coverage to an applicant whose actual risk is substantially higher than the risk known by the insurance company.
To mitigate these challenges, the NHAI is exploring different ways. As per Mint, the plan is to include healthy and unhealthy individuals and increase the risk pool to ensure that younger beneficiaries who are healthy might not avail themselves of the treatment under PM-JAY.
Both state-owned and private hospitals offering geriartic services will be taken on board to offer PM-JAY services. This might also increase premiums, which may lead to higher financial outflow for the government.
“Universal health coverage for people over 70 is an attractive concept, but the actual delivery of healthcare will be logistically complex and has many hurdles to overcome," Dr Rajeev Jayadevan, a leading public health expert told Mint.
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