Comprehensive healthcare needs of India’s rapidly growing elderly population require further policy evolution, aiming for a holistic, sustainable healthcare system for  the aging citizens

India is home to a significant elderly population, with approximately 138 million people aged 60 and above, including more than 10 crore individuals over the age of 70. This segment of the population has unique and pressing healthcare needs. As people age, they are increasingly susceptible to multiple chronic conditions that require specialised care and consistent medical attention. According to the Longitudinal Ageing Study of India (LASI), every fourth Indian over 60 years and every fifth Indian over 45 years reports poor health. Additionally, 75 per cent of the elderly have one or more chronic diseases, and 40 per cent experience disabilities. 1 in 4 elderly individuals has multi-morbidity, with diabetes and cancer rates rising, particularly in urban areas.

As per the Global Health Estimates data of 2019, non-communicable diseases such as ischemic heart diseases, stroke, and diabetes are leading causes of disability-adjusted life years (DALYs) lost among individuals over 60. This highlights the growing need for specialised treatments and consistent medical attention for age-related disorders. The rising prevalence of hypertension, heart disease, and respiratory issues among the elderly increases the need for hospitalisation and specialised care, placing immense pressure on healthcare providers and overwhelming the elderly and their families. The financial burden associated with recurrent hospital visits and treatments is a significant challenge.

Also, India’s current medical inflation rate, standing at approximately 14 per cent which worsens the healthcare difficulties confronting the elderly. Escalating medical costs, including those for hospitalisation, doctor consultations, and medications, make it increasingly challenging for this vulnerable population to access necessary care. Inflation, coupled with the high cost of living, leaves many elderly individuals struggling to afford even basic healthcare services.

Additionally, as medical inflation continues to rise, insurance companies are compelled to cover higher expenses for medical procedures and treatments. This, in turn, results in increased premiums for policyholders. For many elderly individuals, these higher insurance costs compound the financial burden, deepening the overall healthcare affordability crisis.

While the expansion of the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) is a significant step towards improving healthcare access, covering an additional 6 crore individuals from 4.5 crore families, and focusing on seniors aged 70 and above, several challenges persist in the insurance market. Current insurance products are limited, particularly for individuals over the age of 70. Pre-existing diseases (PED) such as diabetes, cardiovascular conditions, and cancer often result in waiting periods or outright denial of coverage. Furthermore, insurance premiums for senior citizens are substantially higher due to the associated health risks, making insurance unaffordable for many. Denial of insurance based on PED, combined with exorbitant premiums, often forces elderly individuals to rely on personal savings or government schemes, leaving them without adequate financial protection against serious illnesses.

According to the United Nations Population Fund (UNFPA), India’s elderly population is projected to nearly triple by 2050, reaching 320 million. This demographic shift will necessitate more comprehensive solutions to safeguard the well-being of the nation’s senior citizens. While the expansion of PM-JAY is a welcome development, it does not fully address the broader geriatric needs of India’s aging population.

AB PM-JAY is largely limited to inpatient care. The scheme does not cover outpatient services, which make up a considerable portion of healthcare costs. Research published in the International Journal of Preventive Medicine shows that outpatient care accounts for 40-80 per cent of health expenditures in India. Consequently, even with the enhanced insurance coverage, many individuals may continue to face out-of-pocket expenses for treatments that do not require hospitalisation.

There is an urgent need to expand coverage to include services such as long-term care, outpatient services, mental health support, palliative care, and rehabilitation, which are essential for ensuring the well-being of the elderly.

Additionally, the government must focus on reducing financial barriers to healthcare, such as high insurance premiums, and ensuring the inclusion of PED coverage without long waiting periods.

(The writer is senior consultant at Enira Consulting; views are personal)