Against the backdrop of an increasingly ageing population, the Centre’s expansion of its Ayushman Bharat health insurance scheme to those over 70 years is expected to bring attention to the healthcare needs of this age-group.  

While a pilot-level roll-out is expected soon to understand nuances of senior care, healthcare industry representatives call for deeper discussions including a scientific costing exercise to understand the special needs of this age group, and to help outline “viable plans” for hospitals.

Last week, the Centre said, its flagship Ayushman Bharat scheme would be expanded to cover those over 70 years. “This expansion is set to benefit around 4.5 crore families, including 6 crore senior citizens, by providing them with free health insurance coverage of up to ₹5 lakh per family,” the Centre said, adding that the benefits would be regardless of the individual’s socio-economic status.

The announcement has been widely welcomed in healthcare industry circles for its “good intent”. Among the positives, is that pre-existing illnesses and other conditions increasingly seen in the elderly, including hypertension, cardiac issues, stroke etc, get covered, said Dr Harsh Mahajan, Chairperson, FICCI Health Services Committee and Founder Mahajan Imaging and Labs. However, he said, a closer look is required to understand if existing healthcare infrastructure had the bed capacity / primary care facilities to support the scheme. Besides, there are other age-related conditions including Dementia, Alzheimer’s, heart, renal, cancer, and mental health issues, for example, that would require special attention.

Treatment Procedure

The Ayushman Bharat scheme is in its seventh year. But several large private healthcare networks are not on-board the initial AB scheme (covering people from economically weaker sections) citing pricing and reimbursement concerns.

Mahajan said, treatment procedure rates need to be viable for more private hospitals to get empaneled with the scheme. Private institutions need to be part of the scheme for it to succeed and for that, viability needs to be built into the system, he said.

Small and medium institutions often operate on tight margins, and the added pressure of accommodating a larger patient base, especially with senior citizens requiring more intensive care, could strain their resources, he observed.

The sustainability of the scheme hinges on reimbursement rates reflecting actual costs incurred by healthcare providers, he said.  Also, timely payments are critical – as delays disrupt cash flow and hinder the ability of hospitals to maintain the quality of care, he added. Without addressing implementation challenges, “there is a risk that the expansion could overwhelm the system, making it difficult for smaller providers to continue participating,” says Mahajan.

Gautam Khanna, Chief Executive of Hinduja Hospital and President, Association of Hospitals , says a good start has been made and the elderly in locations with less healthcare institutions, could in fact benefit.  Healthcare institutions in these locations could be keen to support these schemes, if payments are assured, he said. While private institutions seek viable pricing to participate in the scheme, Khanna explains, Trust-run hospitals already give a percentage of their services entirely free, as mandated.

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