Upgrade healthcare for seniors

Senior citizens have contributed to the building of the nation throughout their lives, but their healthcare remains a challenge today. The National Health Policy recognizes the growing need for palliative and rehabilitative care for all geriatric illnesses and advocates the continuity of care across all levels.

The question however persists--how is all this going to be met with? The Ayushman Bharat Yojana 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 of this age group is faced with 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. While the Delhi government gives a pension of Rs.2000 per month, it is only Rs 400 in Bihar, Rs 500 in UP and Rs 750 in Punjab. It is not possible for a person to sustain life with these negligible amounts, self-sustained healthcare is a faraway dream.

The government has introduced few health insurance schemes to benefit the poor. The Rashtriya Swasthya Bima Yojana (RSBY) for Below Poverty Line (BPL) families, Aam Admi Bima Yojana for rural landless household, Janashree Bima Yojana (JBY) for the BPL and marginally above poverty line, Universal Health Insurance Scheme (UHIS) for poor families.

These schemes provide very minimal healthcare facilities, particularly in cases of hospitalization. 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 Government 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 of the other schemes provide 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 insurance coverage either by the public sector or the private sector insurance companies. Quite difficult for the senior citizens to opt for this choice.

A person is more likely to be taken ill in the elderly age, and incidentally the insurance companies increase the premium exorbitantly with the age of the insured.

This increase has been pronounced in the past few years. A hike from 14 per cent to 18 per cent in the service tax on the basic premium has further escalated the cost of insurance.

For senior citizens who have either no incomes of their own or have very meagre incomes and are dependent on their children, it is evidently impossible to pay high insurance premiums.

With constant decrease of interests on their savings, the situation only compounds. If they develop a serious illness they might have to spend lakhs of rupees in any tertiary hospital for treatment. Futhermore, their day-to-day OPD care needs are not covered by these schemes.

A definite mockery of the situation is that the government pays a premium of Rs 1250 to the public sector companies 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.

Even with the petty premiums of Rs 1250, the company must be making profit by the numbers. There is no need for such stark differences in the premiums.

Many companies have stopped dealing with the cases directly and have appointed TPAs. Their medical knowledge is minimal and are mostly present to put roadblocks in getting reimbursement from the companies.

Only a comprehensive universal health care system can meet the needs of the senior citizens in India. The government must open advanced tertiary care centres where facilities for palliative and rehabilitative care are available.

Insurance companies should be made to compulsorily cover OPD care costs 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 Yojana.

The state owned insurance companies should develop a social welfare approach, outgrow the commercial mindset. Also, there is a need to open special centres for geriatric healthcare.

Geriatric health should be made a critical part of the medical curriculum with the students not only trained to treat their illnesses as fit but with an augmented empathy. The elderly should be issued health cards for the charges to be covered by the government.

It is time the government steps in to provide universal healthcare to all the citizens, and the fleecing by the insurance companies must be put to an end.

Arun Mitra is a freelance journalist. Views are personal.

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