Why in news?
The India Ageing Report 2023, released by the United Nations Population Fund and highlighted in September 2025, warns that rising healthcare costs are straining older Indians. As the elderly population grows, comorbidities and inadequate social support leave many senior citizens facing financial and health insecurity.
Background
India had approximately 149 million people aged 60 and above in 2022 and is expected to have about 347 million by 2050, comprising over one‑fifth of the population. Ageing Indians face a “double burden”: chronic illnesses such as diabetes, hypertension and heart disease, alongside reduced incomes and limited social security. Out‑of‑pocket health expenditure accounts for nearly half of total health spending, forcing many families into debt.
Major health concerns
- Out‑patient care: Elderly people frequently visit doctors for chronic pain, fever, hypertension and breathing problems, reflecting the growing burden of non‑communicable diseases.
- Hospitalisation: Common reasons for admission include heart disease, strokes, complications of diabetes, infections and surgical interventions. These events strain both families and public hospitals.
- Prolonged recovery: Age‑related frailty leads to longer hospital stays, repeated infections and poor adherence to medications, which prolong recovery and increase costs.
Health insurance: status and gaps
- Existing schemes: The Ayushman Bharat–Pradhan Mantri Jan Arogya Yojana (PM‑JAY) covers hospitalisation for poorer households. Many states run additional schemes such as the Chief Minister’s Comprehensive Health Insurance Scheme (CMCHIS). Central Government Health Scheme (CGHS), Employees’ State Insurance Corporation (ESIC) and private insurance plans are available to certain groups.
- Low coverage: Only about one‑fifth of elderly Indians have any form of health insurance. Coverage rates are higher among men and urban residents than among women and rural populations.
- Barriers to enrolment: Low awareness, high premiums and complicated procedures deter older people. In addition, policies often exclude services such as palliative care, physiotherapy and home‑based support.
Why healthcare costs rise with age
- Chronic conditions: Managing lifelong diseases like hypertension and diabetes requires constant monitoring and medication.
- Critical care: Comorbidities frequently necessitate costly intensive care, including ventilator support and specialised procedures.
- High premiums: Private insurers charge higher premiums for older age groups and often reimburse only a portion of expenses.
- Post‑treatment care: Rehabilitation, physiotherapy and home nursing are seldom covered, shifting the burden to families.
- End‑of‑life care: India lacks a structured palliative care policy, leaving terminally ill patients and their families without adequate support.
Initiatives undertaken
- Expansion of PM‑JAY: In 2024 the scheme was widened to cover all citizens over 70 years of age regardless of income.
- Integration of state schemes: States like Tamil Nadu have aligned CMCHIS with PM‑JAY to streamline benefits and enhance coverage.
- National Programme for Health Care of the Elderly (NPHCE): This programme establishes geriatric clinics and regional centres to provide dedicated services to older adults.
- Insurance reforms: Regulators are simplifying enrolment processes and encouraging insurers to offer broader coverage for senior citizens.
- Strengthening public hospitals: Some states have invested in geriatric wards, training and equipment to improve public sector capacity.
Persistent challenges
- High out‑of‑pocket expenditure: Nearly half of health spending still comes directly from households, pushing many elderly into poverty.
- Rural–urban divide: Urban residents have greater access to private hospitals and insurance, while rural elderly rely on household savings and often forego care.
- Insurance gaps: Premiums remain unaffordable for many, and policies exclude essential services.
- Workforce shortages: With only about 6,000 trained geriatricians across India, there is a severe shortage of specialists.
- Neglect of prevention: Preventive measures like vaccinations and early screening receive little attention.
- Gender disparities: Older women are less likely to be insured or financially supported, making them especially vulnerable.
Way forward
- Financial protection: Expand Ayushman Bharat to include palliative, rehabilitative and home‑based care. Introduce tax incentives and savings products that encourage middle‑aged adults to invest in future healthcare needs.
- Access and infrastructure: Strengthen public hospitals, set up geriatric departments in medical colleges and extend primary healthcare services to remote areas through Health and Wellness Centres.
- Preventive health: Implement a national vaccination policy for the elderly and conduct routine screening for chronic diseases at primary health centres.
- Awareness and literacy: Launch campaigns to educate senior citizens about insurance options and healthy ageing. Simplify enrolment procedures and provide outreach through mobile units.
- Human resources: Train more geriatricians and health workers in elder care. Equip ASHA workers and primary health staff to identify and manage age‑related issues.
As India moves towards becoming an ageing society, ensuring that seniors live with dignity, health and financial security will require concerted policy efforts across healthcare, social protection and public awareness.