Both my mother and mother-in-law are above the age 70 years and the news of all the Indian septuagenarians being covered under the Ayushman Bharat (AB) scheme to the tune of Rs. 5 lakhs/ person/ year brought cheers to our hearts. But I thought about another group of individuals that are more vulnerable than the elderly that need to be covered under this scheme which I will come to talk a little later.
I know of many elderly who have health challenges but do not have financial resources to address so they resign to the idea that they have reached the tail end of their life and wait for their time to depart. But this new facility changes all that and instils confidence to seek help.
Apart from the assured health insurance for the 60 million elderly, there will be positive ripple effects on the economy as well in terms of tertiary level hospitals opening the departments of geriatrics & offering related services and opening up of retirement homes for the middle class without the fear of healthcare costs. Such improvements are likely to increase the life expectancy even higher than what it is today
The other equally vulnerable group of individuals that I referred above, is the orphaned abandoned and surrendered children that are eligible for adoption but have special needs.
Apart from them being equally vulnerable, these children have a unique right to receive needed health care services and to remain in their own socio-cultural milieu for adoption as far as possible. India is a signatory of UNCRC (United Nations Convention on the Rights of Children), UNCRPD (United Nations Convention on the Rights of Persons with Disabilities) and the Hague convention in respect of inter-country adoptions which promotes these entitlements.
A statutory body of Government of India for adoptions - Central Adoption Regulations Authority (CARA) developed a set of adoption regulations that are founded on the above-mentioned international instruments along with the domestic legislation called the Juvenile & Justic Act (JJ Act). In it, the second fundamental principle governing adoption states "placement of the child in their own socio-cultural environment, as far as possible".
Mission Vatsalya (an operational instrument of JJ Act that is to strengthen the child protection institutions and services in India) doesn't extend exclusive financial assistance to cover the health care needs of adoption eligible children in its budget for funding of Specialized Adoption Agencies (SAA) and CARA web site's dash board states that more than 65+% of all the available children for adoption in India under the JJ Act are of special needs category. Added to this, there are a few states with zero state run SAA's.
When there is a need, state not extending support but rather expecting the NGOs to pick up the tab for an extended period of time for these most vulnerable children is unrealistic and unsustainable.
So, is it the cost of covering such children under the AB a challenge? It is estimated that the financial burden to implement the scheme for the 60 million septuagenarians in 45 million households would be 2000 crores/ year for the central Government. Simple math tells us that the cost of covering elderly would be Rs. 27.77/ month. At the time of writing this article, there are 2188 adoption eligible children on CARA portal and out of which only 746 (34%) are healthy and the remaining (1442 or 66%) are with special needs. The average of the past 11 years of adoptions in and from India is 3847. Even if we calculate the costs for all these children (healthy + special needs), it comes to be Rs. 106831/ month and Rs. 12.81 lakh/ year. It would be much less if the government chooses to cover only the children with special needs.
It is not the costs, but the challenge is in the process to enroll the OAS children into a health insurance scheme because it requires the details of the parents of a child who he/ she doesn't have.
If the backend processes of the AB scheme can be integrated to include the administrator of the SAA as the guardian of the adoption eligible child, government can certainly afford to pay, and it is doable.
Compared to the OAS children, 60 million elderly form a good voting block that is likely to pay rich political dividends, and it is good politics but ensuring that these OAS children's health and future is secure through AB scheme would be right politics.
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