By Dr. Arun Mitra
Despite the fact that senior citizens have contributed through their life to the nation’s building, healthcare for them remains a big challenge. The National Health Policy recognizes growing need for palliative and rehabilitative care for all geriatric illnesses and advocates the continuity of care across all levels. The question however is how all this is going to be met with. The Ayushman Bharat has serious limitations. It provides healthcare coverage to only 40 per cent of the population, that too for indoor care only. This means 60 per cent of the population is left out of this insurance scheme of five lakh rupees for a family. It is also a well-known fact that 70 per cent of the out of pocket expenditure on health is on outpatient care. This is applicable more to the geriatric group because a person in this age group is faced with the diseases of chronic nature, for which he/she has to pay frequent visits to the outpatient clinics.
Social security schemes for senior citizens in our country are very poor. The old age pension varies from state to state. Whereas the Delhi government gives a pension of Rs.2000/- per month, it is Rs.400/- in Bihar, Rs. 500/- in UP and Rs.750/- in Punjab. With this meagre amount it is not possible for a person to sustain life what to talk of getting quality healthcare.
The government has introduced few health insurance schemes to give benefit to the poor. The Rashtriya Swasthiya Bima Yojna (RSBY) for Below Poverty Line (BPL) families, Aam Admi Bima Yojana for rural landless household, Janashree Bima Yojana (JBY) for below poverty line and marginally above poverty line, Universal Health Insurance Scheme (UHIS) for health care to poor families. These schemes provide very minimal healthcare facilities for hospitalization only.
Employees’ State Insurance Scheme (ESIS) of India, is a multidimensional social security system tailored to provide socio-economic protection to worker population and their dependents covered under the scheme. This schemes covers about three crore workers.
The “Central Government Health Scheme” (CGHS) provides comprehensive health care facilities for the Central Govt. employees and pensioners and their dependents residing in CGHS covered cities. Started in New Delhi in 1954, Central Govt. Health Scheme is now in operation in 27 cities. Barring the ESIS and CGHS, none other scheme provides satisfactory health coverage.
In the absence of any suitable healthcare schemes by the government, large numbers of people especially from the middle income group have started opting for the insurance coverage either by the public sector or the private sector insurance companies. However for the senior citizens, to pay premium for insurance is becoming a nightmare. Whereas a person is more likely to be taken ill in the elderly age, the insurance companies increase the premium exorbitantly with age of the insured. This increase has been marked in the previous few years. 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 public sector unit the New India Assurance Company Limited Premium speaks of this.
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 high insurance premium. With constantly decreasing of interests on their savings, their problems are getting compounded. Any serious illness they might land into will cost lakhs of rupees in any tertiary care hospital. Moreover their day to day OPD care needs are not covered in these schemes.
Mockery of the situation is that the government is paying to the public sector companies a premium of Rs.1250/- for a coverage of Five Lakh rupees under the Ayushman Bharat. While if a senior citizen has to insure the premium it is around Rs.50000/-. It is a common knowledge that even with Rs.1250/- premium the company must be making profit. Then what is the logic of such huge difference in the premium?
Many companies have stopped dealing with the cases directly and have appointed TPAs. The medical knowledge of these TPAs has not been transparent. This has only put blocks on getting reimbursement from the companies.
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 at par with the premium paid by the government in the Ayushman Bharat. The state owned insurance companies should develop social welfare approach instead of totally commercial one. There is need to open special centres for geriatric healthcare. Geriatric health should be part of medical curriculum where the students are trained in their problems and also to develop special empathy for the patients. All the elderly should be issued health cards to get benefit from any doctor for which the government must pay. It would be appropriate and scientific to impose Geriatric health Cess instead of Cow Cess.
It is time government steps in to provide universal healthcare to all the citizens. The fleecing by the insurance companies must be put to an end. (IPA Service)