Greying population growing, without health insurance

mumbai: the absence of health insurance for the elderly is a crisis that looms over an estimated 71 million indians who are above 60 years of age today. with government insurance companies abdicating responsibility for health care of the aged, and private companies offering no alternative, the high cost of hospital care is consequently wiping out individual and family savings.according to health experts, it is as good as condemning a section of the population who may have the means to pay for health insurance but are given no avenue to access it. according to a report, the “greying of india’’—on account of declining fertility and mortality rates—will intensify by 2020,when the numbers of the elderly will reach 120 million, the second highest in the world after china. by then, life expectancy is likely to touch 85 years, and the number of young people available to look after the old will be less, further accentuating the social crisis, says c. yesudian, head of department, health services studies, tata institute of social sciences, mumbai. according to t. ranganathan, trustee, dignity foundation, an ngo concerned with the plight of the elderly, “honest citizens should not be penalised and forced to beg for charity.the government has to provide health security for the aged, and prevent the nexus of malpractice that denies them this protection.’’ an official with a leading insurance company who does not want to be identified says, “my experience of several decades in this field shows that the plight of old people is miserable. neither private nor government insurance companies extend any support to them. public sector insurance scheme of mediclaim undertakes a responsibility for lifelong cover of all citizens, but in reality officials are running these companies as a business.’’ a study of several cases reveals how public insurance companies are abdicating their social responsibility to protect the aged and are harassing them. • a policy seeker over 60 years is unwelcome, and is subject to the highest scrutiny. policy holders above 70 years of age are denied renewal of insurance when they need it most. it especially affects those who have already made one claim. even a 24-hour break in payment of premium is an excuse for rejection by the company. • denial of insurance cover is, in fact, now affecting those even 45 years of age. in many cases the aging process has already started by this time, and they suffer from diabetes or hypertension— conditions identified to be “pre-existing illnesses’’ — and therefore a cause for rejection by insurance companies. • until now individual policy holders were accepted on a principle of ‘utmost good faith’. new guidelines issued by some companies now require them to undergo medical tests, at their own cost, through designated clinics, to identify pre-existing illness or previous episodes of bad health. however, even after this test, the insured will live in fear of rejection of a claim, as the clause of “pre-existing condition’’ has not been deleted. • according to company sources, such a move seeks to discourage individual insurance holders, and push them towards group cover where a medical test is not asked for. strangely enough, the clause of “pre-existing condition’’ does not apply to certain privileged groups such as doctors’ associations, after the first year of their holding a group insurance policy. this generosity at the expense of public coffers does not however extend to other members under this same policy, and old people get the worst end of the bargain. • for instance, an elderly parent having discounted group insurance cover on the credit card of a son or daughter, can be abruptly ejected from the scheme without any written explanation. renewals appear to be a matter of whim, and premiums can be increased without notice. settlement of claims in these group schemes is relegated to some remote branch of the company where nobody is accountable, and is a source of endless trouble to the customer. stressing that privatisation does not solve the problems of the insurance industry, sources say the nexus between the medical profession and top company administrators needs to be tackled. they wonder why no questions are asked about the inflated billing by doctors. for instance, doctor’s fees rise astronomically if extra time is spent in dealing with complications during operations. in many cases these surgeries are unwarranted. there is a huge disparity seen in the cost of surgeries. while a missionary hospital charges rs 60,000 for a bypass operation, what is the rationale behind the rs 3.5 lakhs charged by another ‘charitable hospital’ in the same city? when a patient asks for a receipt, the doctor adds 30 per cent for income-tax coverage. “no other profession is this rapacious. with insurance coffers being squeezed nobody bothers to ask questions. but it is old people who are paying the price, and they are too frail to argue,’’ says the insurance company official.