 "Expansion of AB PM-JAY: A ray of hope for vulnerable elderly patients")
There has been an unprecedent increase in longevity all over the world. While a country like the US is at crossroads to tackle the impact of a rising elderly population, it is good news that India is reforming its healthcare sector to gear up and tackle this issue through various initiatives. For instance, the recently approved expansion of the Ayushman Bharat Pradhan Mantri Arogya Yojana (AB PM-JAY) to senior citizens, who are 70 years and above, will bolster healthcare of the elderly by making it affordable and accessible. This initiative will give confidence to large number of beneficiaries, who will get the benefit of medical care through this scheme that will provide free healthcare treatment worth Rs 5 lakh per family for their elderly members.
I joined the All India Institute of Medical Sciences (AIIMS) in 2010, which means its been over a decade for me in Geriatric Medicine, comparatively a new discipline in medical sciences, in this country. It started in Madras Medical College in 1978, and was gradually launched in other medical colleges, including AIIMS. Under the National Programme for Health Care of Elderly (NPHCE), Geriatric Medicine is offered in many colleges now, to skill doctors to tackle the complex health of elderly people. Better late than never is what I feel, given the facts which suggest that there is a high demand for elderly care, which is only going to double.
According to the UN, the current elderly population of 153 million ( people who are 60 and above) is expected to reach a staggering 347 million by 2050. This demographic shift is not just a figure. Its impact on the social and economic scenario will have far-reaching implications, which is alarming!
A research paper “Medical Spending of the US on Elderly”, published in the National Bureau of Economic Research (NBER) found that medical expenses more than double between ages of 70 and 90 years. There are multiple reasons behind rising medical expenditures for the elderly, including the complex health problems faced by this age group that requires expensive and long-term treatment in the form of rehabilitation and nursing
care. The health problems faced by the elderly are of more complex nature like falls, frailty, dementia, Alzheimer’s disease and social isolation. The elderly are also prone to multi-morbid conditions like hypertension, diabetes, coronary artery disease, old strokes etc.. The existing super specialist-based model proves inadequate in the face of multi-morbid conditions as such patients have to visit multiple specialists and ultimately they land up with prescriptions from multiple specialists which is called polypharmacy (more than five drugs). Similarly, cardio-vascular problems, heart failure, stroke, cancer, and trauma (fall related injuries and fractures) need expensive treatment that demand affordable integrated geriatric care.
People from far away villages visit the centre at AIIMS for treatment. While it is seen that such patients are optimistic of finding the right treatment and living long, the ignorance of kith and kin due to financial healthcare burdens leads to their social isolation. Sometimes, such circumstances result in delay in treatment which can aggravate the patient’s health condition. Therefore, the AB PM-JAY expansion provides a ray of hope for the elderly who are eligible to take treatment under this scheme. Already popular for its free healthcare benefits to the poor and vulnerable families who had to earlier face the burden of catastrophic healthcare expenditure, AB PM-JAY for the elderly is going to bring a similar sense of security to the patients as well as families who ignored the health of the elderly due to expenditure. It is worth mentioning that AB PM-JAY majorly covers all the ailments common among the elderly population, including implantation devices like pacemakers, orthopedic devices, and mental health issues etc.. By taking this decision, the government has extended a hand of care and compassion towards the elderly persons who go through many emotional and health related disturbances.
This scheme should also explore the possibilities of including the vulnerable people who are staying in various long-term care set-ups. Long term care set-ups, which include old age homes, are not very organised in the country and the problem with these set-ups is that the identification documentation of the sheltered is mostly missing due to their abandonment by families or other circumstances. Therefore, it is suggested that these long-term care set ups are covered in the AB PM-JAY.
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From my two decades of experience at AIIMS, I can say that when I used to see patients in 2010, the attitude of elderly people towards ageing was more pessimistic. However, when I meet elderly people now, even those in the 80-85 age group, they show the zeal to live, and to live a healthy life. There are multiple studies that suggest that elderly people suffer maximum from physical disability in their last one or two decades, but as there is a change in attitude, there is a change in hospital seeking behavior of people. This positive behavioral change is going to get catalysed with the insurance cover provided under the AB PM-JAY.
The nation-wide implementation of AB PM-JAY for senior citizens is indeed a welcome initiative of the government.
The author is the Addl. Medical Superintendent, National Centre for Ageing, and Addl Professor, Department of Geriatric Medicine, AIIMS, New Delhi
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