Senior citizen got no benefit under ABARK and PMJAY schemes announced with fanfare by government; another elderly citizen under stress says suicide might be only option if costs become unbearable.
Published Jan 10, 2025 | 7:00 AM ⚊ Updated Jan 10, 2025 | 11:04 AM
(Representational image/Creative Commons)
The pain of stomach cancer and the worry about expensive treatment reportedly made a 72-year-old man in Bengaluru take his own life on Christmas Day, 2024.
A retired state government employee, he was shocked to learn that he would not benefit from the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (ABPM-JAY) that the Union government had announced on 11 September 2024.
Under ABPM-JAY, the government had announced that all senior citizens aged 70 and above who applied for the scheme would receive health insurance coverage of up to ₹5 lakh per family, regardless of income.
The septuagenarian had enrolled for the scheme, but was denied the insurance cover. After his request for insurance cover under ABPM-JAY was declined, he worried that he would burden his son with the treatment expenses.
In its report of this incident, an English newspaper noted that he died 15 days after receiving the diagnosis, soon after he got the shocking news that the insurance scheme he had enrolled for could not be accessed for the treatment.
The family of the senior citizen told the newspaper that they had created an ABPM-JAY senior citizen card, which provides annual cover of ₹5 lakh.
However, the Kidwai Memorial Institute of Oncology (KMIO) denied the benefit, saying the state government orders for implementing the scheme had not yet been issued.
There are several senior citizens who have been denied insurance cover despite the announcement by the Union government.
Karnataka Health Minister Dinesh Gundu Rao agreed that the scheme had not been implemented.
He explained that the state government had written to the Union government in November 2024 seeking clarifications ahead of implementing the scheme, but no reply was received.
“It should not be that Centre announces a scheme, takes credit and we end up paying for it – that is what is happening with AB-ArK (Ayushman Bharat Arogya Karnataka Scheme),” he said on social media site X, in reply to Tejasvi Surya’s post accusing Karnataka Chief Minister Siddaramaiah of showing “disregard for the welfare of Karnataka’s senior citizens by denying them access to emergency health treatment under PM Sri NarendraModi ji’s Ayushman Bharat scheme.”
The Arogya Karnataka scheme was launched in March 2018 by the Karnataka state government as a universal health coverage initiative aimed at providing affordable healthcare to residents.
Later that year, the Union government launched a national scheme named PMJAY in September 2018 to provide health coverage to low-income families across India.
When Ayushman Bharat was rolled out, Karnataka integrated it with the existing Arogya Karnataka scheme, creating the Ayushman Bharat Arogya Karnataka (AB ArK) initiative to combine the benefits of both programmes.
This appeared promising as the scheme, envisioned as a safety net for families in Karnataka, and offered up to ₹5 lakh per year for medical expenses. It was meant as a measure to ease the financial burden of healthcare, especially for low-income families.
Under the new scheme for the elderly announced in 2024, there are 25,02,165 families and 33,40,390 individuals above 70 years of age and eligible to apply in Karnataka.
While such schemes appear like a source of support to the ailing and their caregivers, these are poorly implemented and the problems were evident at the very start of the ABArK scheme.
According to the state health data, only 60 percent of eligible families are even aware of the scheme. Even fewer know how to access the benefits.
A senior health department official explained: “Thousands of hospitals are enrolled under this scheme. However, there is no efficient system to identify the network of hospitals where the scheme is available, leaving several patients and their families suffering without access to the benefits.”
The officer said old patients are forced to wander from one hospital to another seeking one that offers treatment under the government’s insurance scheme.
The state health minister explained on social media site X: “The Ayushman Bharat-Arogya Karnataka Scheme which should be funded 60:40 between Government of India and Government of Karnataka is actually 25:75. We are contributing 75 percent of expenditure.”
The minister told South First that the state government had sought clarifications on the implementation of the senior citizen scheme, but received no response from the Centre.
“I don’t understand why people over 70 need to register and make cards. What is Aadhaar for? They can simply make use of Aadhaar or ration card and avail of treatment as is being done under the Karnataka health scheme,” he said.
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As state and Union governments engage in the game of shifting responsibility, out of pocket expenditure for healthcare has increased to such an extent that even the relatively better off struggle to access treatment.
Senior citizen Nagalakshmi Chandrashekar told South First, “We were shattered by cancer. My husband was diagnosed with lung cancer six months ago – when treatment started, we had no notion how much it would cost. We had to sell our house in Mandya.”
She explained that one chemotherapy session cost between Rs 20-40,000.
“We tried to register under the new scheme announced for the elderly, because it was advertised as one that anyone above 70 could apply for, regardless of income. We have still not been able to do it,”Nagalakshmi said.
She explained that she has already come under a loan of ₹4 lakh in just six months. “It is a struggle to buy medicines for my husband. The scheme looks good only on paper. On the ground, it is a different reality. We don’t know who will fix this, but if it is not sorted out, we will be left with no option but suicide. Why make promises if there is no intention to follow up? If governments cannot help, why promise anything?”
Is the insurance model of healthcare provision one that can be reformed to be more responsive to the needs of the elderly and the vulnerable?
There are people who say streamlining reimbursement processes, creating a robust public healthcare system, and increasing awareness among the rural population so that they know what schemes exist and how to avail them are all necessary for better provision of insurance services in healthcare.
There are others who argue that instead of following the US model of offering insurance cover for health, the government must focus on improving services at the public hospitals. This might be the cheaper and more viable way of providing healthcare services of a decent standard to the whole population.
Prasanna Saligram, a public health expert asserted that instead of channeling precious resources into insurance that appears to benefit only the insurance firms, the government must improve the quality of government hospitals and spend on recruitment of adequate staff and requisitioning the necessary equipment.
“Insurance-based healthcare is a neoliberal project. The worst form of the insurance-based health system is the one in the United States. It is in the nature of the insurance-based system to have more exclusions than inclusions, and it can never be comprehensive care.”
He added, “The governments are in denial that, what they have is an ‘assurance’ model. There is enough evidence (including from CAG reports) that prove irregularities, denials and high out-of-pocket expenses in Ayushman Bharat; the neoliberal dogma taboos government involvement in the provision of services; that leads to an uncritical romance with the private sector. Evidence is accumulating that shows this model is not working, but it is not taken into consideration.”
The Joseph Bhore committee to improve the public health system in India in its report submitted ahead of Independence suggested that “the medical service should be free to all without distinction and that the contribution from those who can afford to pay should be through the channel of general and local taxation.”
So deep is the resentment against insurance firms that decline claims that the murder in December 2024 of the CEO of United Healthcare in the US was greeted not with shock or sorrow on social media, but joy.
(Edited by Rosamma Thomas).
