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May 01
Covering Aurovilians' health costs
- by Carel
The majority of
Aurovilians have no health insurance. But the costs of hospitalization
can be excessive, as has been testified in a number of cases. What is
being done about it? So far, not much.
India's public health care
system, which aims at providing free or subsidized 'Health for All,' is
known to be under severe financial constraints. Public hospitals are
under-funded, understaffed and the treatment provided can consequently
be of poor quality. The huge demand has even led to access problems for
the very poor, forcing them to visit private hospitals or clinics and
accept more expensive treatments. Those who are admitted to public
hospitals still have to meet many incidental expenses that are not
provided freely. Even patients from the lowest income groups often pay
considerable amounts for medicines, laboratory tests, dressings, linen
and food, and sometimes also for treatment itself. The higher income
groups tend to avoid public health services if possible, and go to
private clinics instead.
The financial burden on
households and individuals to cover sudden health care expenses can be
excessive, particularly for individuals who are not or not adequately
insured yet who expect the best treatment available. Aurovilians, almost
without exception, fall into this category.
This is not to say that all
Aurovilians lack coverage for health costs. For the 300 or so
Aurovilians who depend on the community for their monthly maintenance,
Rs 175 per person per month is set aside in an internal health care
fund, which is administered by the Health Care Group. This fund aims at
covering all medical expenses of these Aurovilians, both those connected
with hospitalization as well as out-patient care. In order to minimise
the costs of hospitalisation, the members of the Health Care Group
sometimes prescribe the choice of hospital. They also check all medical
bills that are submitted. It will therefore come as no surprise that the
experience of working for the Health Care Group has not been enjoyable,
as they are subject to a lot of psychological pressure.
The majority of the
Aurovilians, that is all those who are not or only partially dependent
on a community maintenance, have so far been left to their own devices
to find a means to avoid or reduce unexpected health service
expenditure. The costs of hospitalisation nearly always take the lion's
share of these expenses. Though still low in comparison with hospitals
in Europe or the USA, the costs of hospitalisation are nevertheless on
the increase in India. Open heart surgery recently cost an Aurovilian
approximately Rs 3 lakhs (US $ 6,500); an Aurovilian who needed a hip
replacement had to pay over Rs 1.2 lakh (US$ 2,600); a hernia operation
cost Rs 1 lakh (US $ 2,200). There are many more instances where
Aurovilians, faced with an sudden high expenditure for health care,
ended up paying from their private resources. None of them were insured.
Why?
One of the reasons is that
most Aurovilians are unaware of the possibilities of having a health
insurance. But they do exist in India. The Indian General Insurance
Corporation, set up by the government as a public sector undertaking to
market a wide range of insurance services, has introduced the 'Mediclaim'
health insurance scheme, which is now available from most Indian
insurance companies. The standard policy covers only the reimbursement
of hospitalisation and related expenses. It does not cover any
out-patient care and has, as does any insurance, a number of exclusions.
The premium differs for various age groups, but is relatively low. For
an insured sum of Rs 2 lakhs ((US $ 4,300) the yearly premium for
someone in the age group between 45-55 years is about Rs 3,000. (US$
65). As India has recently opened its insurance market to the private
sector, it is expected that soon more companies will offer health
insurance.
While many individual
Aurovi-lians are not aware of the existence of health insurance in
India, the Economy Group certainly was. As early as June, 1998, its
attention was called to the possibility of taking out a collective
Mediclaim insurance for all Aurovilians. However, the Economy Group
never followed up on this. Instead, some of its members expressed a
preference to cover all medical expenses of all Aurovilians and
newcomers through an internal fund, rather than 'going outside.'
A recent development is that
the Health Care Group, after studying the implications of this
preference, has concluded that this move would most probably be
financially unfeasible for Auroville (the community, with only 1500
members, is judged by experts as 'too small' for an internal health
insurance system and there is an aging population) and would also place
too heavy a burden on the members of the Health Care Group as their work
would more than double. Instead of fully covering all medical expenses
internally, the Health Care group has now proposed that Auroville goes
for a mixed system, e.g. a collective health insurance from outside,
together with an in-house Health Care Fund. The latter would then cover
any costs exceeding the health insurance coverage plus the costs of
out-patient care. The proposal has the advantage that a major part, if
not all of the costs of hospital treatment - which are the major health
care costs - would be covered by the insurance. Since the insurance
allows the individual a free choice of hospital anywhere in India, it
has the additional advantage that the individual can make his/her own
choice of hospital and choose what he or she perceives as the best
treatment available, instead of burdening the Health Care Group with
making an impossible decision.
It is hoped that a decision
will be taken soon. For those not presently insured, such a decision is
long overdue.
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