The Ayushman Bharat scheme’s extension to cover those over 70 offers a flicker of hope in the labyrinth of India’s healthcare system. While the government promises to ease the burden of rising out-of-pocket expenses, the scheme leaves critical gaps in coverage. This expansion, while commendable, focuses on secondary and tertiary care, but remains silent on outpatient care—an essential area for senior citizens grappling with chronic illnesses. As life expectancy rises and health conditions multiply with age, the extension feels like a patch, not the systemic overhaul India desperately needs.
Ayushman Bharat: A Bandage on a Deep Wound
The Ayushman Bharat scheme, launched with grand promises, has recently extended coverage to include those aged over 70, regardless of income. At first glance, it appears to be a step in the right direction, targeting nearly 60 million senior citizens, who often find themselves grappling with exorbitant healthcare costs. With India boasting some of the highest out-of-pocket healthcare expenses globally, this gesture from the Union government is indeed laudable. It offers up to ₹0.5 million per year in free health coverage, a significant relief for many.
However, the problem with the scheme is more structural than its benevolent surface suggests. The focus is almost entirely on secondary and tertiary care, while outpatient care, which accounts for up to 80% of healthcare costs for the elderly, remains glaringly absent. Chronic diseases often plague those over 70, and these are largely managed through outpatient care, diagnostics, and medication—not hospital admissions. The absence of such essential coverage means that while the elderly may have access to hospitals, they remain vulnerable to the far more frequent, everyday medical expenses.
Out-of-Pocket Expenses: The Unspoken Burden
The conversation around India’s out-of-pocket expenses cannot be overstated. A staggering 60% of health expenditure in the country is borne by individuals themselves, pushing many into poverty. For the elderly, especially those over 70, the financial toll is often unbearable. While the Ayushman Bharat scheme aims to reduce this burden, its limited scope in addressing outpatient needs leaves a gaping hole in its execution.
Consider this: someone suffering from diabetes or hypertension doesn’t need surgery or hospital admission as often as they need regular medication and routine checkups. This population isn’t clamoring for expensive tertiary care. They need affordable medicines, accessible diagnostics, and consistent outpatient care. Yet, the scheme remains tethered to hospitalization, leaving seniors vulnerable to the very expenses they incur most frequently.
The Limits of Secondary and Tertiary Care Focus
The scheme’s emphasis on secondary and tertiary care has raised eyebrows among public health experts. India’s public healthcare system is already strained, with tertiary care hospitals bearing the brunt of a system poorly equipped at the primary level. Instead of relieving this burden, the Ayushman Bharat scheme risks further overwhelming tertiary care institutions, pushing the public sector towards an unsustainable model.
By focusing on hospitalization, the scheme sidesteps the need to invest in strengthening primary and secondary care facilities. India’s healthcare model, as it stands, leans heavily towards curative rather than preventive care. This means that by the time a patient lands in a tertiary care facility, their condition is often far more serious—and far more expensive to treat—than it would have been had they received proper primary care earlier.
The Missed Opportunity in Outpatient Care
For a scheme that purports to revolutionize healthcare access, the omission of outpatient care is perhaps its greatest flaw. Outpatient services encompass consultations, medications, and diagnostic tests—areas that make up the bulk of medical expenses for the elderly. This demographic, living longer yet suffering from a range of chronic conditions, often needs regular outpatient visits, not just emergency hospitalizations.
Had the Ayushman Bharat scheme included provisions for outpatient care, it would have been a genuine game-changer. Unfortunately, the omission of these critical services renders the scheme incomplete. It forces individuals to dip into their savings—or take loans—to afford the very healthcare they should be receiving as a public right. The problem is particularly acute in smaller cities and rural areas, where access to even basic healthcare services remains limited.
Primary Health Care: The Forgotten Pillar
The failure of the Ayushman Bharat scheme to focus on primary healthcare is not just an oversight; it’s a symptom of a larger malaise in India’s health policy. Thailand, in contrast, invested heavily in primary healthcare by diverting funds from urban hospitals to rural areas, building an extensive network of health centers that cater to the population’s basic health needs. India, by comparison, is heading down a path more reminiscent of the U.S., where reliance on insurance-based models has led to skyrocketing healthcare costs and inequities in care.
What India needs is a robust primary healthcare system that serves as the foundation for the entire healthcare apparatus. By neglecting this essential pillar, the Ayushman Bharat scheme merely perpetuates a cycle of dependency on curative, high-cost tertiary care. The burden on tertiary care institutions is likely to increase as a result, without significant improvements in patient outcomes.
The Private Sector: A Growing Influence
Another consequence of the scheme’s focus on hospitalization is the growing influence of the private sector. While private hospitals account for two-thirds of the total money spent under the Ayushman Bharat scheme, the public healthcare sector continues to struggle. This reliance on private institutions for the implementation of public health initiatives is concerning, especially when reports indicate waning enthusiasm in the private sector due to low treatment rates and delayed payments.
In southern states, where healthcare infrastructure is comparatively stronger, private hospitals account for 53% of all money spent under the scheme. This growing reliance on private players poses a risk to the long-term sustainability of India’s healthcare system. If the government continues to prioritize insurance-based models and hospitalization over strengthening public health infrastructure, it risks further deepening the divide between the rich and the poor when it comes to access to quality healthcare.
The U.S. Experience: A Cautionary Tale
The parallels between India’s Ayushman Bharat scheme and the U.S. healthcare system are hard to ignore. The U.S., long criticized for its exorbitant healthcare costs and reliance on insurance-based models, serves as a cautionary tale for India. The U.S. healthcare system, driven by private insurance companies and expensive tertiary care, has led to one of the most unequal systems in the world, where access to care is often determined by one’s ability to pay.
India is now at a crossroads. It can either continue down this path, allowing private sector players to dominate the healthcare landscape while ignoring the urgent need to strengthen public healthcare, or it can learn from the failures of the U.S. model and invest in a more equitable system focused on preventive and primary care. The Ayushman Bharat scheme, in its current form, risks falling into the same trap that has plagued the U.S. for decades.
A Call for Comprehensive Reform
The Ayushman Bharat scheme, in its present form, offers a glimmer of hope but falls short of the comprehensive reform needed to address India’s healthcare crisis. What’s needed is a broader vision that goes beyond insurance and hospitalization, one that focuses on strengthening primary healthcare, expanding outpatient care coverage, and reducing the country’s reliance on the private sector.
As India’s population continues to age, the challenges facing the healthcare system will only become more pronounced. The government must act now to ensure that the Ayushman Bharat scheme is not just a temporary fix but a long-term solution that addresses the root causes of the country’s healthcare problems. Only then can India truly achieve its goal of universal healthcare for all.
FAQ
How does the Ayushman Bharat scheme benefit seniors over 70?
The Ayushman Bharat scheme’s recent expansion to include seniors aged over 70 offers critical health coverage, especially in a country where healthcare costs can be devastating. The scheme promises ₹0.5 million per year in free healthcare for senior citizens, which covers hospitalization in both private and public hospitals for secondary and tertiary care. This financial aid is vital for seniors facing expensive surgeries or treatments that would otherwise be unaffordable. However, it’s important to note that this scheme primarily focuses on hospitalization, and many of the day-to-day healthcare needs—such as consultations, medications, and diagnostic tests—are not covered.
What gaps still exist in the Ayushman Bharat scheme?
While the Ayushman Bharat scheme does offer relief for over 70 seniors, the absence of coverage for outpatient care is a major flaw. Seniors, especially those managing chronic diseases like diabetes, hypertension, or arthritis, require regular medical consultations and medications that are not included under the scheme. Outpatient expenses account for a significant portion of healthcare costs, especially for the elderly, as they often deal with recurring treatments rather than emergency hospitalizations. Without coverage for outpatient services, seniors are still left to bear a large financial burden, which defeats the purpose of comprehensive healthcare access.
How does the scheme address the issue of out-of-pocket expenses?
India has some of the highest out-of-pocket expenses in healthcare, and the Ayushman Bharat scheme aims to mitigate this burden for its senior citizens. By offering free healthcare for hospitalization, the scheme helps reduce the financial strain of treatments that require surgeries or long-term hospital stays. However, since it excludes outpatient care, seniors must still pay for regular check-ups, medications, and diagnostic tests out of pocket. This gap in coverage means that while seniors may be shielded from the exorbitant costs of hospitalization, they are still vulnerable to the continuous costs of managing chronic illnesses.
Why is the focus on secondary and tertiary care problematic?
The Ayushman Bharat scheme is heavily focused on secondary and tertiary care, which includes hospitalization and specialized treatments. While this is essential for addressing major health issues like surgeries, cancer treatments, or emergencies, it overlooks a key aspect of senior healthcare: primary healthcare. Most senior citizens, particularly those over 70, require frequent doctor visits, prescriptions, and routine check-ups to manage chronic conditions. The focus on hospitalization instead of strengthening primary care systems results in a healthcare model that is reactive rather than proactive, addressing severe health problems but not preventing them.
How does the private sector influence the Ayushman Bharat scheme?
A substantial portion of the funds under the Ayushman Bharat scheme goes to private hospitals. Approximately two-thirds of the healthcare spending under this scheme is directed toward private institutions, which have more facilities for secondary and tertiary care than public hospitals. In southern states, 53% of the funds have been utilized by private hospitals. However, this reliance on private players can lead to unequal healthcare access. Delays in payments and low treatment rates may result in private hospitals being less willing to participate, which could lead to fewer options for patients in need, particularly in underserved regions.
Is Ayushman Bharat heading down the same path as the U.S. healthcare system?
Many critics argue that India’s Ayushman Bharat scheme mirrors some of the troubling aspects of the U.S. healthcare system, particularly its focus on insurance-based models for tertiary care. The U.S. model has led to spiraling healthcare costs, driven by the dominance of private players and expensive hospital treatments. By focusing on insurance for hospitalizations rather than investing in a robust primary healthcare system, India risks creating a similar system where the costs of healthcare skyrocket, and quality care becomes accessible only to those who can afford it. A shift towards a more preventive and primary-care-centered model is essential to avoid this trajectory.
What are the implications of neglecting outpatient care for the elderly?
Neglecting outpatient care in the Ayushman Bharat scheme has severe consequences for the elderly. Many seniors suffer from chronic conditions that require ongoing treatment, including regular consultations, tests, and medication. By not including these services in the scheme, seniors remain vulnerable to the financial strain of managing their health on a daily basis. For instance, a person managing hypertension will require lifelong medication and regular monitoring, but without outpatient coverage, they will continue to bear these costs, pushing many into financial distress despite the supposed benefits of the scheme.
What is the role of primary healthcare in reducing tertiary care demand?
Countries like Thailand have demonstrated that investing in primary healthcare reduces the need for expensive tertiary care. By diverting funds from urban hospitals to rural health centers, Thailand has built a healthcare system that emphasizes prevention and early intervention. This approach reduces the burden on hospitals and minimizes the need for costly surgeries and emergency treatments. In contrast, India’s focus on hospitalization without a strong primary healthcare foundation increases the pressure on tertiary care institutions, where treatments are often more expensive and complex.
How can the government improve the Ayushman Bharat scheme?
To make the Ayushman Bharat scheme truly effective, the government must expand its coverage to include outpatient care, strengthen primary healthcare, and reduce its reliance on private hospitals for secondary and tertiary care. Incorporating outpatient services like doctor consultations, diagnostics, and medicines will provide seniors with the comprehensive healthcare they need to manage chronic conditions. Furthermore, investing in public health infrastructure, especially in underserved areas, will reduce the burden on tertiary care facilities and ensure that healthcare is accessible to all citizens, not just those living near private hospitals or urban centers.
Is Ayushman Bharat enough to achieve universal health coverage?
While the Ayushman Bharat scheme is a step towards achieving universal health coverage, it is far from sufficient in its current form. The exclusion of outpatient care and the overwhelming focus on secondary and tertiary care mean that millions of seniors will still face significant financial challenges in managing their health. To truly achieve universal health coverage, the government must address the gaps in primary care, outpatient services, and rural healthcare access. Only then can India build a healthcare system that protects all citizens, particularly its aging population.
Sunil Garnayak is an expert in Indian news with extensive knowledge of the nation’s political, social, and economic landscape and international relations. With years of experience in journalism, Sunil delivers in-depth analysis and accurate reporting that keeps readers informed about the latest developments in India. His commitment to factual accuracy and nuanced storytelling ensures that his articles provide valuable insights into the country’s most pressing issues.
