Health insurance for seniors

BJP’S poll manifesto has promised to extend Ayushman Bharat health insurance scheme to ‘cover Senior Citizens’. This is required as almost 20% of India’s population is projected to be above the age of 60 by 2050

RELEASING THE manifesto of the Bharatiya Janata Party (BJP) for the Lok Sabha elections on April 14, Prime Minister Narendra Modi said “everyone over the age of 70 years” would be brought under the Ayushman Bharat health insurance scheme, “whether they are poor, middle class, upper middle class”.

According to the BJP’S manifesto, the Ayushman Bharat-pradhan Mantri Jan Arogya Yojana (AB-PMJAY) scheme, the world’s largest government-funded health insurance scheme, will be expanded to “cover Senior Citizens and provide them access to free and quality health care”.

The scheme was launched in 2018 to alleviate the burden of out-of-pocket expenditure on the poor, and help them access critical medical treatments and emergency care that were previously financially unattainable.

Currently, AB-PMJAY provides a coverage of Rs 5 lakh to its 65 crore beneficiaries (13.44 crore families), who are identified using specific deprivation and occupational data from the 2011 Socio-economic Caste Census (SECC). The BJP’S poll promise, for the first time in India, seeks to make universal health coverage a reality for a whole cohort of senior citizens.

An ageing population

India’s declining fertility rate and increasing life expectancy means that its population is growing old. At the time of the 2011 census, only 8.6% of India’s population was over the age of 60 years. This proportion is, however, expected to increase to 19.5% by 2050, according to the government’s Longitudinal Ageing Study in India (LASI), published in 2020.

In terms of absolute numbers, the population over the age of 60 years will nearly triple, from 103 million in 2011 to 319 million in 2050. “The ageing population will mean increased expenditure on health and long-term care, labour force shortages, public dissaving, and old-age income insecurity,” the study said.

Thus, offering coverage to senior citizens has huge public health implications, given that they live with the highest burden of chronic health conditions, which drive up their healthcare costs.

Diseases among the elderly

Self-reported data from LASI show that 35.6% of those above the age of 60 are afflicted by cardiovascular diseases such as heart attacks and strokes. In comparison, the prevalence of such disease in the 45-59 years age group was found to be 21.9%.

Similarly, the self-reported prevalence of hypertension among senior citizens was found to be 32%, compared to 21% for the 4559 years age group. And this is likely to be an under-count, as studies have shown that nearly 40% of people are unaware of their hypertension status. Diabetes afflicted 13.2% senior citizens, LASI found.

The self-reported prevalence of diagnosed chronic lung disease among senior citizens is 8.3%, while 19% in the age group suffer from chronic bone or joint disease. The self-reported prevalence of diagnosed cancer was found to be 0.7% among those aged 60 and above. This was higher in urban areas (1.1%) than in rural areas (0.5%), the LASI report said.

Beyond chronic, non-communicable diseases and their complications, the elderly are also more prone to infectious diseases due to their weakened immune systems.

Inadequate coverage at present

According to the India Ageing Report 2023, just over 20% of India’s population above the age of 60 years is currently covered under health insurance schemes. These include Central Government Health Scheme, Employees State Insurance Scheme, Rashtriya Swasthya Bima Yojna, cooperative health insurance schemes, medical reimbursement from an employer, and privately purchased health insurance.

The coverage is higher among elderly men (19.7%) than women (16.9%), although there is not a big rural-urban divide in the coverage, the study reported.

LASI, on the other hand, says that about 26% of households in the country are covered under some form of health insurance, mostly under government schemes. According to the report, only 1% of households have commercial health insurance policies. “The out-of-pocket health expenditures account for more than 70% of health expenditures in India, leading to health vulnerabilities in the older population,” according to LASI.

The India Ageing Report found that the main reasons for a lack of coverage in elderly are low awareness (52.9%) and non-affordability (21.6%).

How Ayushman Bharat helped

According to official data on AB-PMJAY, the government has incurred the highest expenditure for five key specialties covered under the scheme: cardiology, general medicine, general surgery, orthopaedics, and medical and radiation oncology. The data also show specific procedures emerging as focal points for expenditure. These include hemodialysis for advanced kidney failure, percutaneous transluminal coronary angioplasty (PTCA) with diagnostic angiogram (a minimally invasive procedure crucial for opening narrowed or blocked heart arteries), hip implants, and cataract surgeries.

This data indicate that the government is already incurring most of the expenditure in providing treatment predominantly required by the elderly population. It also shows that beneficiaries are saving a substantial amount of out-of-pocket expenditure, which they would not have been able to do without the scheme.

According to government estimates, in rural India, a patient suffering from cardiovascular disease spends Rs 6,919 in government hospitals, and Rs 42,759 in private facilities, per hospitalisation. For cancer, this expenditure was at Rs 23,905 per case in government hospitals, and a staggering Rs 85,326 per case in private ones.

In urban areas, the situation is worse. In government hospitals, the average expenses for cardiovascular disease and cancer are Rs 6,152 and Rs 19,982 respectively. However, in private hospitals, these costs surge to an alarming Rs 68,920 and Rs 1,06,548 respectively.

The scenario is no different when it comes to musculoskeletal issues. In rural government hospitals, the average expenditure per case is Rs 4,722, which rises to Rs 8,164 in private hospitals. In urban areas, government hospital costs are around Rs 6,152 per case, but private hospitals demand a hefty Rs 60,657 per case.