After adding the cost of medicines and other items, the patient had to shelve nearly Rs.40000/- per day. This is an amount beyond the capacity of our people who are already in deep economic crisis as a result of lockdowns, loss of jobs and livelihood. According to Pew Research Centre the number of people earning less than $2 has doubled from 5.9 crore to 13.4 crore during Pandemic and as per study by the Centre for Sustainable Employment at Azim Premji University 23 Crore people earn less than Rs.375/- per day.

People in the elder age group have been the worst hit by the COVID-19. By the time of attaining this age many people are retired and become dependent on their children even for day to day living. 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 2017 laid emphasis on the need for palliative and rehabilitative care for all geriatric illnesses, but in practice hardly any steps have been taken.

To meet health needs the government’s focus is on insurance based healthcare instead of health as state’s direct responsibility. The Ayushman Bharat has serious limitations. It provides healthcare coverage to only 40% of the population, that too for indoor care only. This means 60% of the population is left out of this insurance scheme. It is also a well-known fact that 70% of the out of pocket expenditure on health is on outpatient care. This affects 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.

Moreover there are several conditions to get benefit of the Ayushman Bharat scheme. Those who own a two/three/four wheeler or a motorised fishing boat; Those who own mechanised farming equipment; Those who have Kisan card with a credit limit of Rs. 50000/-; Those who work in government-managed non-agricultural enterprises; Those earning a monthly income above Rs.10000/-; Those owning refrigerators and landlines; Those with decent, solidly built houses; Those owning 5 acres of more of agriculture land. (https://www.bajajfinserv.in/insights/ayushman-bharat-yojana-are-you-eligible-for-the-pmjay-scheme) are not entitled to get benefit under Ayushman Bharat.

Several other healthcare schemes include 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), Central Government Health Scheme” (CGHS) and Ex-Servicemen Contributory Health Scheme (ECHS) are better in this respect and provide both OPD and indoor care without any limits. Under the ESI scheme total beneficiaries number around 3.2 Crore employees or about 13 crore of their family members. The other two schemes provide benefit to about 50 lakh employees. During the COVID peak most of the ESI hospitals were converted to COVID hospitals. As a result the employees were not able to get treatment for other illnesses for which they had to go to the private hospitals and pay from their own pocket.

In the absence of any suitable healthcare schemes by the government, big chunk of our population which is in unorganised sector, is left with choice to opt for health insurance coverage either by the public sector or the private sector insurance companies. However to pay premium for insurance is becoming a nightmare. That is why even the middle income group people are now at receiving end.

Paradox is that whereas a person is more likely to be taken ill in the elderly age and looses regular income, the insurance companies increase the premium exorbitantly with age of the insured. The rate of premium of these companies has increased tremendously in the previous 5 years. For example under the Mediclaim policy of public sector unit, the New India Assurance Company Limited, premium for those in the age group of 66-70 for a sum assured Rs.100000/- increased from Rs. 5600/- in the year 2016 to Rs. 19866/- in 2021, an increase of 354%; and for sum assured 2 lakh from Rs. 10630/- to Rs. 28218/- an increase of 265% in the last 5 years. For a sum assured of Rs.5 Lakh it increased from Rs. 24230/- to Rs. 42120/- that is a rise of 173% during this period.

For the Senior citizens, who have either no income of their own or have very meager income and are dependent on their children, it is impossible to pay such high insurance premium. Pandemic has exposed this myth of insurance based health care system. No company will cover if the expenses increase beyond the sum assured. Patients requiring ventilators had to spend much more than this amount during uncertainties of the outcome. So they had to either borrow or sell their assets.

The companies have stopped dealing with the cases directly and have appointed TPAs. This has been done only to put blocks on getting reimbursement from the companies by raising frivolous objections.

Therefore only a comprehensive universal health care system can meet the needs of our people. The government should strengthen the primary healthcare. They should 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 insured. The irony is that tariff of the government owned companies is more than the private sector companies in some cases. (IPA Service)