Ageing and Health Burden in India

Syllabus: Vulnerable Sections

Source: TH

Context: The India Ageing Report 2023 highlights the mounting challenges of healthcare costs for senior citizens in India, especially amidst rising comorbidities, low insurance coverage, and inadequate financial preparedness.

About Ageing and Health Burden in India:

Background:

• India’s elderly population (60+) stood at ~149 million in 2022; projected to reach 347 million (20.8%) by 2050.

• Elderly face a “double burden”: Health – multiple comorbidities such as diabetes, hypertension, heart disease, arthritis, stroke. Finance – reduced income, high dependency, poor social security.

• Health – multiple comorbidities such as diabetes, hypertension, heart disease, arthritis, stroke.

• Finance – reduced income, high dependency, poor social security.

• Out-of-pocket expenditure (OOPE) remains high (~48% of total health spending, National Health Accounts 2021-22), causing distress financing and debt.

Major Health Concerns of the Elderly:

• Out-Patient Care: Elderly frequently seek treatment for chronic pain, fever, hypertension, diabetes, and breathing/heart issues, reflecting the burden of non-communicable diseases.

• In-Patient Care: Hospitalisation is commonly required for heart disease, stroke, diabetic complications, infections, and surgeries, increasing financial and physical stress.

• Recovery Issues: Longer hospital stays, repeated infections, ICU needs, and poor drug compliance due to costs make recovery slower and more difficult.

Insurance Coverage: Present Status and Gaps

• Schemes Available: Central (PM-JAY) and state schemes like CMCHIS, along with CGHS, ESIC, and private health insurance, provide varying levels of coverage.

• Coverage Remains Low: Only 20% of elderly are insured, with higher coverage among men and urban residents compared to women and rural populations.

• Barriers: Low awareness (52.9%), high premiums, and complex enrolment processes restrict access to health insurance.

• Exclusions: Key services like palliative care, physiotherapy, rehabilitation, and home oxygen support are not covered, forcing out-of-pocket spending.

Cost of Healthcare: Why It Rises with Age?

• Chronic NCDs: Lifelong conditions like diabetes and hypertension require constant medication and monitoring, raising cumulative expenses.

• ICU/Critical Care: Comorbidities in elderly patients often demand high-cost ICU admissions and ventilatory support.

• Private Insurance Premiums: Premiums rise steeply with age, while reimbursements are often partial (about 75%), leaving large gaps.

• Post-Treatment Costs: Rehabilitation, physiotherapy, and home-based care after discharge are typically uncovered and expensive.

• End-of-Life Care: No structured policy for palliative or terminal care leaves families bearing heavy financial burdens.

Initiatives Taken:

• PM-JAY Expansion (2024): Provides universal health coverage for all citizens above 70, regardless of income.

• State Schemes Integration: States like Tamil Nadu integrate local schemes (CMCHIS) with PM-JAY to widen access.

• NPHCE: Establishes geriatric clinics and regional centres for elderly-specific care across the country.

• Health Insurance Reforms: Simplification of enrolment and broader coverage aims to boost participation among elderly.

• Public Hospital Strengthening: States such as Kerala and Tamil Nadu have improved public geriatric healthcare infrastructure.

Challenges:

• High OOPE: Nearly half of healthcare costs are out-of-pocket, devastating for elderly with limited or no income.

• Rural-Urban Divide: Urban elderly access private hospitals and insurance, while rural elderly largely depend on household savings.

• Insurance Gaps: High premiums, exclusions, and low awareness make insurance inaccessible for most senior citizens.

• Workforce Shortage: India has only ~6,000 trained geriatricians, insufficient for its rapidly ageing population.

• Palliative & Preventive Neglect: Preventive measures like vaccination and palliative care remain underfunded and poorly integrated.

• Gender Inequality: Elderly women are less likely to have insurance or financial support, heightening their vulnerability.

Way Forward:

• Financial Protection:

• Expand Ayushman Bharat to include palliative, rehabilitative, and home-based care. Regulate private insurers to cap premiums for elderly. Incentivise middle-age savings for healthcare (tax-deductions, health bonds).

• Expand Ayushman Bharat to include palliative, rehabilitative, and home-based care.

• Regulate private insurers to cap premiums for elderly.

• Incentivise middle-age savings for healthcare (tax-deductions, health bonds).

• Accessibility:

• Strengthen public hospitals for geriatric care (model of TN & Kerala). Rural outreach through Health & Wellness Centres under Ayushman Bharat.

• Strengthen public hospitals for geriatric care (model of TN & Kerala).

• Rural outreach through Health & Wellness Centres under Ayushman Bharat.

• Preventive Health:

• National vaccination policy for elderly (influenza, pneumonia, shingles). Early screening for diabetes, hypertension, cancers at PHCs.

• National vaccination policy for elderly (influenza, pneumonia, shingles).

• Early screening for diabetes, hypertension, cancers at PHCs.

• Awareness & Literacy:

• Nationwide awareness campaigns on health insurance. Simplified enrolment procedures, mobile units for rural elderly.

• Nationwide awareness campaigns on health insurance.

• Simplified enrolment procedures, mobile units for rural elderly.

• Human Resources:

• Establish geriatric departments in medical colleges. Train ASHA workers and primary health staff in geriatric care.

• Establish geriatric departments in medical colleges.

• Train ASHA workers and primary health staff in geriatric care.

Conclusion:

India is becoming an ageing society, making elderly healthcare vital for inclusive growth. The India Ageing Report 2023 urges urgent reforms in affordability, accessibility, and insurance. True to Dr. Ambedkar’s vision of equality, today’s challenge is dignity in ageing—ensuring the elderly live with health, security, and respect, free from debt or neglect.