UPSC Editorial Analysis: Healthcare for the Elderly in India
Kartavya Desk Staff
Source: IE
*General Studies-2; Topic: Welfare schemes for vulnerable sections of the population by the Centre and States and the performance of these schemes; mechanisms, laws, institutions and Bodies constituted for the protection and betterment of these vulnerable sections.*
Introduction
• The Indian government has extended the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) to include a Rs 5 lakh top-up for adults aged above 70 years.
• This extension is aimed at supporting approximately 4.5 crore families not covered by other public health insurance schemes, targeting to prevent catastrophic healthcare expenditures (CHE) that impoverish households.
Background:
• India’s Ageing Population: India is experiencing one of the fastest rates of ageing globally. While life expectancy has increased to 70 years, the average number of healthy life years is only 63.5.
• India is experiencing one of the fastest rates of ageing globally. While life expectancy has increased to 70 years, the average number of healthy life years is only 63.5.
• Health Concerns: India faces a rising burden of non-communicable diseases (NCDs) and disabilities, particularly within the 70-80 and 80-plus age groups. Chronic conditions such as diabetes, cardiovascular diseases, and cognitive impairments are becoming prevalent among the elderly.
• India faces a rising burden of non-communicable diseases (NCDs) and disabilities, particularly within the 70-80 and 80-plus age groups.
• Chronic conditions such as diabetes, cardiovascular diseases, and cognitive impairments are becoming prevalent among the elderly.
• Insurance Gap: Only 20% of people above 60 have health insurance coverage, leaving the majority vulnerable to high healthcare costs.
• Only 20% of people above 60 have health insurance coverage, leaving the majority vulnerable to high healthcare costs.
• Economic Strain: Nearly 50% of Indian households seeking healthcare face catastrophic healthcare expenditures (CHE), with about 15% of them being pushed into poverty as a result.
• Nearly 50% of Indian households seeking healthcare face catastrophic healthcare expenditures (CHE), with about 15% of them being pushed into poverty as a result.
Economic Impact:
• Out-of-pocket Expenditure: Healthcare spending for the elderly is twice as high for inpatient care compared to younger populations, due to the higher prevalence of chronic illnesses and the need for more frequent hospitalizations.
• Healthcare spending for the elderly is twice as high for inpatient care compared to younger populations, due to the higher prevalence of chronic illnesses and the need for more frequent hospitalizations.
• Informal Sector Vulnerability: With 92% of India’s workforce in informal labour, many lack access to employer-based health insurance, further increasing the financial strain caused by poor health in older age.
• With 92% of India’s workforce in informal labour, many lack access to employer-based health insurance, further increasing the financial strain caused by poor health in older age.
• Cost of AB-PMJAY Extension: The extension of AB-PMJAY is estimated to cost around Rs 14,282 crore annually, far exceeding the allocated budget, highlighting a significant gap in funding for elderly healthcare.
• The extension of AB-PMJAY is estimated to cost around Rs 14,282 crore annually, far exceeding the allocated budget, highlighting a significant gap in funding for elderly healthcare.
Challenges and Opportunities:
• Budget Shortfall: The current budget allocation is four times less than what is required for effective implementation of the scheme, limiting its scope and reach.
• The current budget allocation is four times less than what is required for effective implementation of the scheme, limiting its scope and reach.
• Narrow Coverage: AB-PMJAY primarily covers secondary and tertiary care, leaving out outpatient services, which account for 46% of total health expenditure in India.
• AB-PMJAY primarily covers secondary and tertiary care, leaving out outpatient services, which account for 46% of total health expenditure in India.
• Long-term and Preventive Care: The scheme doesn’t cover critical aspects of elderly care such as long-term care, preventive care, and palliative care, all of which are crucial for managing the ageing population. This presents an opportunity to redesign healthcare policies to cater more effectively to older adults.
• The scheme doesn’t cover critical aspects of elderly care such as long-term care, preventive care, and palliative care, all of which are crucial for managing the ageing population.
• This presents an opportunity to redesign healthcare policies to cater more effectively to older adults.
Social Implications:
• Family Structures and Dependency: The increasing trend of nuclear families is creating a care gap, leading to rising economic dependency and care poverty among the elderly. Without extended family support, many older adults face financial and social insecurity.
• The increasing trend of nuclear families is creating a care gap, leading to rising economic dependency and care poverty among the elderly.
• Without extended family support, many older adults face financial and social insecurity.
• Demographic Transition: India is undergoing a demographic transition, altering the age structure, disease profiles, labour market structure, and migration patterns. These changes will have a profound impact on social and economic policies, particularly for healthcare and social security.
• India is undergoing a demographic transition, altering the age structure, disease profiles, labour market structure, and migration patterns.
• These changes will have a profound impact on social and economic policies, particularly for healthcare and social security.
• State-level Variations: States like Kerala, which have faster rates of ageing, will require adapting social security policies to address the specific needs of an older population, including healthcare and retirement benefits.
• States like Kerala, which have faster rates of ageing, will require adapting social security policies to address the specific needs of an older population, including healthcare and retirement benefits.
Future Projections:
• Expansion of AB-PMJAY: Around 5.6 crore households are expected to be eligible under the extended scheme, with an estimated 43.5 lakh families expected to use it annually.
• Around 5.6 crore households are expected to be eligible under the extended scheme, with an estimated 43.5 lakh families expected to use it annually.
• Impact of Demographic Shift: The ongoing demographic shift will have far-reaching effects on labour markets, healthcare demand, and social services, with the elderly population projected to increase significantly over the coming decades.
• The ongoing demographic shift will have far-reaching effects on labour markets, healthcare demand, and social services, with the elderly population projected to increase significantly over the coming decades.
Government Schemes:
• Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY): A flagship health insurance scheme providing coverage for secondary and tertiary care.
• A flagship health insurance scheme providing coverage for secondary and tertiary care.
• Extension for Elderly: The new top-up under AB-PMJAY offers Rs 5 lakh coverage for individuals aged above 70, aiming to alleviate healthcare costs for an increasingly vulnerable section of the population.
• The new top-up under AB-PMJAY offers Rs 5 lakh coverage for individuals aged above 70, aiming to alleviate healthcare costs for an increasingly vulnerable section of the population.
International Best Practices:
• Canada’s healthcare model views health as a form of human capital and ensures access to healthcare as a public service.
• European nations focus on holistic care, integrating preventive, curative, and palliative services.
• Australia’s healthcare system emphasizes public service with robust primary care and long-term care systems for the elderly.
Way Forward:
• Increase Public Health Spending: India should increase public health spending from the current 0.9% to 1.35% of GDP to support a more robust healthcare system, especially for the elderly.
• India should increase public health spending from the current 0.9% to 1.35% of GDP to support a more robust healthcare system, especially for the elderly.
• Expand Infrastructure: There is a need to expand public health infrastructure, increase hospital coverage, and improve healthcare human resources to cater to the needs of the ageing population.
• There is a need to expand public health infrastructure, increase hospital coverage, and improve healthcare human resources to cater to the needs of the ageing population.
• Integrate Care Support: There must be better integration between primary and tertiary care for ageing populations, alongside preventive care.
• There must be better integration between primary and tertiary care for ageing populations, alongside preventive care.
• Promote Healthy Ageing: By promoting healthy and active ageing, India can potentially reap the benefits of a ‘silver dividend’, where an active elderly population continues to contribute to society and the economy.
• By promoting healthy and active ageing, India can potentially reap the benefits of a ‘silver dividend’, where an active elderly population continues to contribute to society and the economy.
Conclusion
• In conclusion, addressing the healthcare needs of the elderly is crucial for India as the population ages rapidly.
• The extension of AB-PMJAY is a positive step but must be complemented with broader reforms in healthcare, social security, and long-term care to ensure a dignified and healthy life for older adults.
Practice Question:
India’s elderly population faces unique healthcare challenges, including a higher prevalence of non-communicable diseases and disabilities. Evaluate the current healthcare infrastructure in India for addressing these challenges, and suggest policy measures to ensure preventive, curative, and palliative care for the ageing population. *(250 words)*