Why India extending Ayushman Bharat health cover to those aged 70+ is important| #instantanalysis

Summary

The Indian government has expanded the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PMJ) to cover all citizens aged 70 and above, benefiting around 4.5 crore families. This expansion aims to provide cashless hospitalization up to ₹5 lakh for secondary and tertiary care. The scheme, which was previously limited to lower-income families, now also covers those in the lower middle class who lack healthcare protection. While the move promises to improve health coverage, challenges such as underfunding and access to treatment remain to be addressed.

Takeaways

• 😀 The government has expanded the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PMJAY) to include all Indians aged 70 and above.
• 😀 This expansion is beneficial for around 4.5 crore families and 6 crore senior citizens, particularly those from the middle class.
• 😀 Senior citizens from middle-class families who were previously excluded are now eligible for cashless hospitalization benefits under the scheme.
• 😀 The AB PMJAY offers a cashless hospitalization benefit of up to ₹5 lakh for secondary and tertiary healthcare services in empaneled hospitals.
• 😀 Initially, AB PMJAY aimed to cover 12.3 crore beneficiaries based on socioeconomic status, but a large portion of the lower middle class lacked healthcare protection.
• 😀 The government recognizes this gap as the 'missing middle,' which primarily consists of lower middle-class families without access to government or private insurance.
• 😀 Those aged 70 and above, who were previously excluded from the scheme, can now benefit from this expansion and receive healthcare protection.
• 😀 Families already covered by AB PMJAY will receive an additional ₹5 lakh top-up cover per year for those over 70 years of age.
• 😀 Individuals who are part of other public health insurance schemes like CGHS, ECHS, or CAPF can choose either their existing scheme or opt for AB PMJAY benefits.
• 😀 Private health insurance policyholders and those covered under the Employees' State Insurance Scheme (ESIC) are also eligible to avail of the AB PMJAY benefits.
• 😀 Despite the expansion, there remain long-standing challenges such as underfunding, treatment denial by hospitals, and difficulties in accessing treatments, which may affect the scheme's effectiveness.

Q & A

What is the significance of the government's recent expansion of the Aayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PMJAY)?

The government's recent expansion of AB PMJAY is significant as it extends health coverage to all Indians aged 70 and above. This will benefit approximately 4.5 crore families and 6 crore senior citizens, particularly those in the middle-income category who were previously excluded from government health schemes.

How many senior citizens are expected to benefit from this expansion?

The expansion is expected to benefit approximately 6 crore senior citizens, particularly those in the 70+ age group.

What health benefits does the AB PMJAY scheme provide to its beneficiaries?

AB PMJAY offers beneficiaries cashless hospitalization for secondary and tertiary healthcare services at empaneled hospitals, with a coverage of up to ₹5 lakh per year.

Which socio-economic groups were covered under AB PMJAY before this expansion?

Before the expansion, AB PMJAY was aimed at offering health protection to 12.3 crore beneficiaries based on their socio-economic status, primarily targeting low-income and vulnerable families.

What does the term 'missing middle' refer to in the context of this scheme?

The 'missing middle' refers to the lower middle-class population in India, which lacks health coverage as they are neither eligible for government insurance schemes nor can they afford private health insurance.

How will the expansion of AB PMJAY benefit senior citizens in the 'missing middle' category?

Senior citizens aged 70 and above from the 'missing middle' will now be eligible for health coverage under AB PMJAY, which previously excluded them due to their inability to afford private insurance or access government schemes.

Will families already covered under AB PMJAY see any changes in their coverage?

Yes, families already covered under AB PMJAY will receive an additional top-up cover of ₹5 lakh per year for the senior citizens aged 70 and above within their households.

Can beneficiaries who are already enrolled in other public health insurance schemes benefit from AB PMJAY?

Yes, senior citizens aged 70 and above who are already covered by other public health insurance schemes, such as the Central Government Health Scheme (CGHS) or the Ex-Servicemen Contributory Health Scheme (ECHS), can either continue with their existing schemes or opt for AB PMJAY.

What challenges have been associated with the AB PMJAY scheme in the past?

Challenges include issues such as underfunding, denial of treatments by empaneled hospitals, and difficulties in accessing treatments by eligible beneficiaries. These have been long-standing concerns that need to be addressed for the expanded scheme to be effective.

What is expected to happen next regarding the enrollment process for the expanded AB PMJAY scheme?

Detailed guidelines on how the new group of beneficiaries can enroll for the expanded AB PMJAY scheme are expected to be shared soon by the government.