Editorial 1 : Reaping the Silver Dividend
Context: Why extending national health insurance scheme to elderly is not enough
Expansion of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY)
- India’s social security system for older adults is inadequate.
- Government’s decision to extend AB-PMJAY with a Rs 5 lakh top-up for all older adults aged above 70 years, not covered by other public health insurance schemes, is a step in the right direction.
- The move will provide much-needed support for the elderly in times of increasing nucleation of families, rising economic dependency and care poverty.
- However, it’s not a game-changer.
Present Situation in India
- India is the world’s most populous country and also among the fastest ageing.
- Although country’s life expectancy is 70 years, the healthy life years are only 63.5.
- There is an increasing burden of non-communicable diseases, disabilities and a bedridden older population, especially in the 70-80 and 80+ age group.
Insurance Penetration
- High-risk pooling mechanisms and heavy premiums in private health insurance companies, especially for the older population, are major hindrances in healthcare coverage.
- Only 20% of population above 60 years is covered by health insurance.
- With nearly 92% of the workforce engaged in informal labour, the financial burden caused by poor health is often devastating.
- Out-of-pocket (OOP) healthcare spending for inpatient care is twice as high for the elderly compared to the younger population.
Limitations of Extending the AB-PMJAY
- Insufficient budget allocation
- The government has allocated an additional budget of Rs 3,437 crore for AB-PMJAY to cover the proposed extension.
- However, national and state-wise preliminary estimates, show the need for a greater increase in funds to cover the intended beneficiaries’ health care.
- Protecting vulnerable older adults through public insurance should be complementary to, but not a substitute for, government hospital care.
- Majority of illnesses like diabetes, cardiovascular, respiratory and gastrointestinal diseases, cancer, vector borne diseases, injuries are not likely to be cured in a single episode of treatment. They will require long-term care.
- The AB-PMJAY, like most other private insurance schemes, covers only secondary and tertiary care conditions, when outpatient services account for 46% of the total health expenditure.
- The exclusion of outpatient care from the scheme will not help in preventive care, critical for healthy ageing.
- The scheme does not help with palliative care, a common requirement for the 80+ group or the bed-ridden amongst the relatively younger group of the elderly who suffer from chronic diseases.
- Depending on insurance-based schemes can inflate the cost of the healthcare system as a whole.
- Extending the beneficiary base of the AB-PMJAY will not be enough to achieve the public health goals of the country without a substantial rise in public health spending.
Need to increase public health spending and reforms
- Public healthcare spending has been stagnant at around 0.9 to 1.35% of the GDP for more than seven decades.
- The expansion of insurance coverage needs to be supplemented with expansion of public health infrastructure and hospital coverage and increase in healthcare human resources and medicine supply.
- India’s healthcare system needs more holistic reforms that integrate primary and tertiary care support, especially for the ageing population whose health issues often demand continuous attention.
Way Forward: Promoting healthy and active ageing is non-negotiable to reap the silver dividend or the direct and indirect economic and non-economic contributions made by the older population.
Conclusion: AB-PMJAY is a crucial intervention to avoid impoverishment caused by catastrophic health spending. But it is inadequate to ensure the well-being of the ageing.
Editorial 2 : Fertiliser Cap and Cut
Context: How a fertiliser cap can help fuel India
User Competition for Raw Materials
- Chemical fertilisers are made from fossil fuels and minerals having alternative industrial uses.
- Ammonia, the key input of nitrogenous fertilisers such as urea, is derived from natural gas that is also a transportation fuel and feedstock for petrochemicals and power generation.
- A similar user competition is now happening with rock phosphate ore.
- Rock phosphate ore is raw material for manufacturing di-ammonium phosphate (DAP) and other phosphorous-containing fertilisers.
- It is increasingly used as the cathode (positive electrode) source in electric vehicle batteries, replacing more costly nickel, manganese, cobalt and aluminium oxides.
Situation for India
- India imports nearly half of its natural gas consumption and hardly has any mineable phosphate, potash or elemental sulphur reserves.
- Therefore, Indian agriculture is particularly vulnerable to global price spikes and supply disruptions.
- This gives rise to the need of focusing on efficient nutrient application.
- Earlier farmers had to be incentivised to use chemical fertilisers for boosting crop yields. Today, they need to be restrained from over-application.
- But government’s policy of under-pricing urea and DAP, does the opposite.
Measures to be taken
- Government must take measures to cap, the consumption of high-analysis fertilisers like urea, DAP and muriate of potash.
- Farmers should be persuaded away from such high nutrient fertilisers to complexes and water-soluble fertilisers containing less of these nutrients that can be delivered directly to the plant’s root zone or sprayed to the leaves.
Benefit of capping fertilisers
- Improved nutrient use efficiency will allow reduction in the consumption of bulk fertilisers and also imports of their intermediates and raw materials.
Conclusion: The sustainability of Indian agriculture lies both in more crop per drop (of water), and more crop per kg (of nutrients).