Good, but not enough: On Ayushman Bharat scheme

The Union government's recent decision to extend the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) to senior citizens aged over 70, regardless of their income, is a significant step towards expanding health coverage. This policy aims to offer up to ?0.5 million per year in free health coverage, benefiting nearly 60 million elderly individuals. However, this extension has raised concerns about the adequacy of the scheme in addressing broader public health needs.

Limitations of the Scheme:

• Scope of Coverage: The AB PM-JAY scheme focuses solely on secondary and tertiary care hospitalisation, excluding outpatient care, diagnostics, and medicines. Given that a significant portion of elderly health expenditure is on outpatient care, this limitation is a critical shortfall.
• Public Health Infrastructure: The scheme's impact is hampered by the inadequate primary and secondary healthcare infrastructure in many regions, particularly outside southern states. Without a robust primary healthcare system, there is an increased burden on tertiary care facilities, which the scheme cannot fully address.
• Private Sector Reliance: A significant portion of funds under PM-JAY has been directed towards private hospitals, leading to concerns about the scheme's sustainability and effectiveness. This reliance on private sector care might undermine the goal of strengthening public healthcare.

Comparative Insights and Recommendations:

• Global Comparisons: Countries like Thailand have effectively strengthened primary healthcare by reallocating funds from urban hospitals to rural health centers, achieving better universal health coverage. In contrast, the U.S. model, which relies heavily on insurance-based schemes, has led to high healthcare costs, highlighting potential pitfalls for India.
• Need for Comprehensive Care: To meet the public health objectives, India needs to focus not only on providing insurance coverage but also on enhancing the primary and secondary healthcare infrastructure. This approach will reduce the load on tertiary care and make the PM-JAY scheme more effective.
• Future Directions: A more integrated approach that combines insurance coverage with robust public healthcare services could improve the scheme's effectiveness. Strengthening primary and secondary care will be crucial in addressing the comprehensive needs of the elderly population.

Practice Question:

Q. “PM-JAY is a measure that is essential, but is incomplete.” Comment