Calling for universal healthcare
For senior citizens, health through insurance is a pipe dream that demands urgent reforms
The National Health Policy 2017 document commits itself to providing culturally appropriate community-centred solutions to meet the health needs of the ageing community in addition to compliance with Constitutional obligations as per the Maintenance and Welfare of Parents and Senior Citizens Act, 2007. This policy recognises the growing need for palliative and rehabilitative care for all geriatric illnesses and advocates the continuity of care at all levels. The question, however, is how all these changes are going to be accommodated.
Social security schemes for senior citizens in our country are very meagre. The government has introduced few health insurance schemes to give benefit to the poor. The Ministry of Labour and Employment has launched the Rashtriya Swasthiya Bima Yojana (RSBY) to provide health insurance coverage for Below Poverty Line (BPL) families. Beneficiaries under RSBY are entitled to hospitalisation coverage up to Rs. 30,000. Employees' State Insurance Scheme (ESIS) of India is a multidimensional social security system tailored to provide socio-economic protection to the worker population and their dependants covered under the scheme. The Central Government Health Scheme (CGHS) provides comprehensive health care facilities for the central government employees for pensioners and their dependents residing in CGHS covered cities. Started in New Delhi in 1954, the Central Government Health Scheme is now operational in 27 cities. Aam Admi Bima Yojana, a social security scheme for rural landless household, was launched on October 2, 2007. The premium of Rs 200 per person per annum is shared equally by the Central Government and the State Government. The members to be covered should be aged between 18 and 59 years. Janashree Bima Yojana (JBY) was launched in August 2000. It provides life insurance protection to people who are below the poverty line or located marginally above the poverty line. Persons aged between 18 years and 59 years and who are members of the identified 45 occupational groups are eligible to be covered under the scheme.
As regards the Universal Health Insurance Scheme (UHIS), the four public sector general insurance companies have been implementing the scheme for improving access to health care to poor families. The scheme provides for reimbursement of medical expenses up to Rs 30,000 towards hospitalisation floated amongst the entire family. Only18 per cent of people in urban areas covered by any kind of health insurance scheme. Health Minister JP Nadda had said in a written reply in the Lok Sabha that "...percentage of persons having coverage under any health insurance scheme is 14.1 per cent in rural areas and 18.1 per cent in urban areas."
These schemes, barring the CGHS and ESIC, offer only premium-based limited coverage. With increasing cost of medical treatment, this coverage does not meet the requirements, particularly of the elderly. Moreover, these provide only hospitalisation benefits, OPD care is not covered. For day to day health care, people have to visit doctors in the OPD and spend on medicines and investigations. Whereas a person is more likely to be taken ill at an older age, the insurance companies increase the premium exorbitantly with age of the insured. This increase has been marked this year. The increase in the service tax from 14 per cent to 18 per cent GST on the basic premium has further escalated the cost of insurance.
The data of the mediclaim policy of New India Assurance Company Limited Premium speaks of this. For an ordinary person even from the middle-income group to pay such high premiums is almost impossible. The premiums with escalating value cover costs only of a single patient. The premium for the family will increase by several manifolds.
For the senior citizens who have either no income of their own or have very meagre income and are dependent on their children, it is impossible to pay the insurance premium. With the regular lowering of interests on their savings, their problems are getting further compounded. Any serious illness they might land in will cost lakhs of rupees in any tertiary care hospital. Moreover, their day to day OPD care needs are not covered by these schemes. Therefore, only a comprehensive universal health care system can meet the needs of the senior citizens. The government must open its advanced tertiary care centres where facilities for palliative and rehabilitative care are available. Insurance companies should be made to compulsorily cover OPD care cost as well for the senior citizens. Insurance premium for the senior citizens should be reduced substantially. The state-owned insurance companies should develop a social welfare approach instead of a totally commercial one. Old age pension in Punjab to the amount of Rs. 750 per month is a harsh joke. IPA
(Dr. Arun Mitra is an ENT specialist based in Ludhiana. He is the Senior Vice-President of Indian Doctors for Peace and Development and member of Alliance of Doctors for Ethical Health care in India. The views are strictly personal.)