Beyond health cover: Why Ayushman Bharat has still not aced its true test

livemint.com:

Subscribe to enjoy similar stories. Among the raft of Cabinet decisions announced last week, the one to extend the Ayushman Bharat health insurance scheme to all citizens aged 70 years and above, irrespective of income, was the biggest headline-grabber. The Pradhan Mantri Jan Arogya Yojana currently provides a ₹5 lakh health cover to the bottom 40% of India’s population.

The Centre reckons that the expansion will benefit around 60 million senior citizens, with an outlay pegged at ₹3,437 crore. The move comes at a time when India’s population is set to grey faster than ever before. An estimated 4.3% of India’s population is over 70, with the share projected to rise to 9.7% by 2050, according to the United Nations.

Health events occur at a more rapid rate among the elderly. As they are more likely to have pre-existing conditions, insurance companies charge them a hefty premium and cover them with more exclusions. All of this makes the government’s move timely.

Also read: Why GST Council cannot ignore the health insurance row Since its inception in 2018, the Ayushman Bharat health insurance scheme has catered to 68.6 million hospital admissions worth ₹90,204 crore, according to the health ministry, with nearly an equal split between men and women, and 30,510 empanelled hospitals, as per official data. Yet, for all its claimed successes, cracks are visible. The scheme has suffered consistent gross underutilization of funds, and the claims settlement ratio has fallen from 97.5% after launch to 81.7% in 2023-24, government data show.