Utilisation patterns under publicly funded health insurance can serve as policy signals. Discuss with reference to elderly care in India.

Ayushman Vay Vandana extends AB PM-JAY cover to every citizen aged 70 or above. It recorded 23.46 lakh authorised admissions worth ₹5,668.80 crore in two years [1]. The National Health Authority logs every claim digitally, so this data shows both what the elderly need and where the system fails them.

What utilisation reveals about elderly health needs

• Disease burden: cataract surgery leads by volume (4.71 lakh, about 20%). This points to a backlog of age-related vision loss [1].
• Cost drivers: PTCA (angioplasty) leads by value (about ₹649 crore), and chronic haemodialysis is second by volume. Heart and kidney disease is the main fiscal risk [1].
• Rising demand: there were 7.89 lakh admissions in year one [2] and about 15.6 lakh in year two. Claims are growing far faster than the PM-JAY budget.

Signals for policy design

• Missing primary care: dialysis is the end stage of poorly controlled diabetes and blood pressure. That control happens in out-patient care, which is about 38% of current health spending [3] and is excluded from the card. Families' share of total health spending (out-of-pocket spending) rose again to 43.4% in 2022-23 [4].
• Leakage risk: the CAG audit of PM-JAY found duplicate IDs and ineligible beneficiaries on its lists [5]. High-value packages and matching with the CGHS/ECHS lists therefore need closer audit.
• Access gap: only about 94 lakh seniors had enrolled by December 2025 [6], against about 6 crore eligible [7]. Low claims in a region may mean people are being left out, not that they are healthy.

Limits of reading claims as signals

• Claims count only those who reach an empanelled hospital. Homebound people aged 80 and above, mostly widowed women, stay invisible.
• Published data is not broken down by State, gender or income, so equity cannot be judged.
• Hospitals may perform more of the high-value packages because they pay more, not because patients need them [5].

Utilisation data thus works like a policy radar for elderly care. Several steps would let India move from paying for end-stage illness to supporting healthy ageing: phased out-patient, test and medicine cover as recommended by the Parliamentary Standing Committee [8], vision screening at Ayushman Arogya Mandirs, and claims data published by State, gender and age. This would honour Article 41's promise of public assistance in old age and SDG 3.8 on universal health coverage.