Page 48 - The Insurance Times August 2024

FEATURE

Insurance for all in Ayushman seniors'

family in govt plans

T he Centre is exploring a dozen different models needed healthcare for elderly family members and other

to extend the benefits of its marquee free
essential household expenditures," said K. Srinath Reddy,
healthcare insurance scheme-Ayushman Bharat
former president of Public Health Foundation of India (PHFI).
Pradhan Mantri Jan Arogya Yojana (AB PM-JAY)-
to senior citizens, according to two officials with knowledge "It will also enable elderly persons to be fit and functional,
reduce their dependency, and make further economic and
of the development. social contributions to society. This measure will promote
The move is in keeping with a promise made by the ruling social harmony," he added.
NDA (national democratic alliance) in the run-up to the According to government's population projection report
general elections to cover all people 70 years of age and 2011-2036, there are nearly 104 million elderly persons in
above in the PM-JAY. India, of which 53 million are women and 51 million men.
"Different models are being studied by the government to With the new policy that is in the works, there may be a
implement AB PM-JAY for senior citizens 70 years of age and possiinter-generational bility that having a senior member
above," said the first official cited above, adding that the
in a family will be a criterion to be eligible for the scheme
government is working out the mechanics of how to extend
regardless of whether they are listed in socio-economic caste
the scheme.
census 2011 (SECC 2011) database or not. The scheme origi-
The National Health Authority (NHA), which has been nally picked beneficiaries from this database.
tasked with formulating the plan, is actively looking at two This may also give an opportunity to non-poor families to ben-
preferred models among the several being considered. efit from the scheme. Another likely challenge that the gov-
"Two models are being studied to take the initiative forward- ernment may face in implementing all families having senior
all family members with senior citizens may get covered, or citizens is "adverse selection", which means all intended ben-
only senior citizens in a particular family will get the health eficiaries can immediately avail treatment under the scheme,
coverage," said the second official cited above. even for pre-conditions, without any waiting period.
Accordingly, health benefit packages are being firmed up for In the insurance industry, adverse selection refers to situa-
geriatric treatment, with hospitals providing dedicated geri- tions in which an insurance company extends insurance cov-
atric services to be onboarded for PM-JAY. Geriatric therapy erage to an applicant whose actual risk is substantially
is a medical specialty focused on the care of the elderly. higher than the risk known by the insurance company.

"The budget proposal has been submitted with a view to in- Health benefit packages are being looked into for geriatric
crease the beneficiary base of AB PM-JAY," said the second treatment as per the need of the elderly population. Mean-
official. "It is likely that the government may mention the while, hospitals providing dedicated geriatric services will be
implementation of PM-JAY for eligible senior citizens during the taken on board to offer PM-JAY services. This includes both
Union budget. Government meetings are being done internally stateowned and private hospitals.
to explore the mechanism and how to start with it." The scheme's utilization could also increase premiums, which
During the release of Bharatiya Janata Party's (BJP's) elec- may lead to higher outflow for the government.
tion manifesto, Prime Minister Narendra Modi had an- "Universal health coverage for people over 70 is an attrac-
nounced that all senior citizens above 70 years will be cov- tive concept, but the actual delivery of healthcare will be
ered under PM-JAY scheme, across poor families, middle logistically complex and has many hurdles to overcome," said
income groups and even economically wellto-do families. Dr Rajeev Jayadevan, a leading public health expert, add-

"Extension of PM-JAY's coverage to the elderly will help pre- ing that by default, the group has a higher burden of dis-
vent families from exercising painful choices between ease and medical expenses. (Source: Mint)

44 August 2024 The Insurance Times