Health care for Senior Citizens at Affordable Cost: Meeting Minutes

Minutes of the Meeting on Health care for Senior Citizens at Affordable Cost Arranged by All India Senior Citizens’ Confederation [AISCCON] & Andhra Pradesh Senior Citizens’ Confederation on [APSCCON] June 7, 2009


Minutes


1.0] General -A meeting on “Healthcare for Senior Citizens at Affordable Cost” was jointly organized by APSCCON and AISCCON at Heritage Hospital on 7th June 2009. Twenty One participants attended the meeting, coming as they did all the way from Delhi, Mumbai, Guntur, and of course Hyderabad. Besides members from APSCCON & AISCCON, FAPSCO was represented by Sri Gopal Rao & Bhagawanulu; Federation of Elder Homes in AP by Dr Koteswar Rao. Representatives from Harmony, IMA, APNA were absent. As if to compensate this loss, Star Health unit connected with Aarogyasri participated with four members including their COO -- Sri RS Ganapathy. Invitees from Chennai could not attend as they were having AGM and elections today.

Sri KR Gangadharan of Heritage played the host with his inimitable and enviable hospitality as usual.

The meeting was chaired by Sri KS Sastry, most competent for the occasion, as he was the Chairman of IRDA Committee on the subject of the meeting.


2.0] Initial remarks: Participants introduced themselves. Prof Visweswaraiah welcomed the gathering. Sri RN Mital explained how heath care has become unaffordable due to rising costs, how the meager savings made during decades of service in low cost economy years is dwindling and why immediate action is necessary to support senior citizens in meeting the health care expenditure.

Mr. Mital pointed out that the mandate in the National Policy on Older Persons to provide Health Security to Senior Citizens at affordable cost was only partially implemented or ignored in most of the States in our Country. It was particularly so because there was no unified approach to this issue by Senior Citizens themselves.

This meeting was therefore, organized to arrive at a unified approach for follow up both at the State and National level


3.0] Sri Sastry suggested that both the points (unaffordable heath care costs & Concept of Family Clinics / Family doctors) be taken up together.

What they spoke: Mr. K.S.Sastry invited suggestions of the participants on the points in the Agenda

Sri D.N. Chapke said that health care should be responsibility of the government. Senior Citizens should commit themselves to an agreed line of approach.

Sri Sainath [Aarogyasri] opined that the entry of non-BPL senior citizens into Aarogyasri scheme must be automatic. That is, anyone reaching 60 should be included by default.

In Tamilnadu, Aarogyasri is already available to State Government employees. This will be further extended to others, as Star has won the bid.

Sri Karulkar suggested that all states must be pressurized to replicate Aarogyasri.

Sri IVLN Chary said that tapping hospitals of Charities and Trusts is necessary to take advantage of lower charges. He also stated that the efforts should start from grass root level, say by organizing Mohalla Committees.

Sri Gopal Rao suggested several tiers of classification based on Income and said Government must take responsibility for middle class too. He also suggested some sort of cess may be levied for generating money needed for Senior Citizens Health Care.

Sri Bhagwanulu emphasized on the role that SCAs have to play.

Dr Koteswar Rao felt that money is not a problem provided we are ready to prove our credibility. He also observed that Banks refuse to lend money for construction of Old Age Homes even when the borrower has land for mortgaging. This is proving to be a major handicap in setting up new Old Age Homes.

Sri Kaka Samant made a strong plea that Sastry Committee report should not be lost sight of. Consistent follow up is necessary.

Dr. Sugan Bhatia said that IRDA protects the interests of insurers only and in IRDA’s views Senior Citizens are not part of customers of Health Insurance. Senior Citizens Associations should have representation in Advisory committee of IRDA. Providing assistive technologies may minimize dependency on hospitalization.

Sri S.K.Mahaptra supported Kaka Samant’s views on Sastry Committee Report and felt Family clinics should be supported.

Sri Srinivasulu emphasized that there should be a separate ministry for senior citizens at state level.

He also informed that GHMC will train 100 Bedside assistants at an expenditure of Rs 4.2 Lakhs shortly. The plan of action with respect to 84 SCAs & 50 DCCs for the year has been finalized by Aasara.

Dr Vyasamoorthy said that while we approach the government we should ask only for those things that are do-able or achievable and defer items that may never be taken up by the government.

Kerala is the only state having a policy on Palliative care / Hospices

Prof Visweswaraiah read out four demands from his paper.

Sri Venkateswarlu lamented that middle class is ignored by government.

Summing up Sri Sastry summed up the discussions. He pointed out that, as far as NPOP is concerned, government suggests, in the case of APL category, only a combination of Health Insurance and public Healthcare. Subsidies towards Health Care are thought of by the Government only for BPL families. Therefore we need to go via Health Insurance channel, if we want to achieve anything. IRDA is not equipped to handle Health insurance, especially for senior citizens. There has to be an advisory committee on IRDA on this. We should continue the dialog with IRDA.


4.0] Assessment of Various Current Health Care Scheme The Afternoon session was devoted to studying alternative schemes such as Sastry Committee report , Sahayadri Scheme in Pune, Rashtriya Swasth Bima Yojana [RSBY] of GOI, Yashaswani in Bangalore, and Aarogyasri in Andhra Pradesh.

Mr. Mital pointed out that the health Committee of The All India Senior Citizens’ Confederation [AISCCON] has laid down following minimum requirements of an insurance scheme for Senior Citizens,

· Premium should be modest and should not keep increasing with age

· There should be no entry age bar at least for the initial period of 3 to 4 years.

· There must be no exit age bar if the premia are paid regularly.

· No bar on cover for pre-existing diseases.

· The schemes should be automatically renewable on payment of premium.


It was also felt that the segment of population which is above the BPL level but below the Income Tax level [ that is Middle Class or APL] is the real sufferer. Therefore, our considerations may be focused on this segment as our target population.

Above minimum requirements are used as the yardstick to judge the suitability of a scheme for Senior Citizens.


Sastry Committee Report -Mr.Mahapatra and Mr. Kaka Ssamanth observed that Sastry Committee recommendations were a big step forward as far as requirements of Senior Citizens are concerned. It met the requirement of providing cover without Age bar at least during the 3 year window period, covers pre-existing diseases with some conditions and also provides portability and automatic renewing and to some extent OPD treatment.

However, it falls short of our following requirements,

· Premium is likely to be beyond the reach of lower Middle Class Senior Citizens

· It keeps increasing with age as it can be loaded every year for age and health condition.

· Cover on pre-existing disease is loaded with pre-conditions which may make this facility un-acceptable; for example the Insurance Companies have laid down a waiting no claim period of 4 years before pre-existing diseases can be covered.


However, it is the most comprehensive landmark study of this subject and if it is implemented honestly, it will provide an excellent solution to the health insurance requirements of at least the upper middle class Senior Citizens. .


Saihyadri Scheme - Dr. Sugan Bhatia explained that the Saihyadri Scheme was promoted by Federation of Senior Citizens of Maharashtra [FESCOM] in Pune and a socially committed Hospital chain. It is observed that,
· The average expenses per Insured person do not exceed around Rs. 1200’per year even in a super specialty hospital and even when there is no entry or exit age bar or restrictions on account of pre-existing diseases.

· When the scheme was first introduced in 2005 the Hospital expenditure per insured Senior Citizen was only around Rs. 650.

· The number of persons who enrolled was around 17000 when it was launched with a premium of Rs. 450 per one Lakh cover, now the number of insured has dropped to about 5000 when the premium was raised to Rs 1200 per person

· Even at this low number of insured the scheme appears to have broken even and is being continued.

· The expenses per insured is high because it is a voluntary scheme and not mandatory and the group consists of only Senior Citizens [60+].


The Scheme was found acceptable and effort was made to replicate it in Hyderabad but
no Hospital was forthcoming to implement it.


Rashtriya Swasth Bima Yojna [RSBY] – This scheme is similar to Arogya Sri Scheme with following features,

· It is partly subsidized by GOI

· Premium is Rs 30/year for a cover of Rs 30,000/- per family on floater basis

· No restriction on entry & exit age and pre-existing diseases.

· All most all medical procedures are covered.

· BPL families are covered.

· In Kerala it has been extended to APL families also on payment of Rs 100/- per year per family. Entire Kerala is now covered by Health Insurance.



But its negative features are,

· Cover is very small

· Family size is restricted to 5. in case of a big family, the Senior Citizen members are likely to be left out


The Yashaswani Scheme, Dr . Bhatia pointed out, is a very successful scheme in

Karnatak covering major medical procedures at a very low premium. Even at this low premium they have built up a substantial surplus, but its success is largely due to the existence of an extensive network of co-operative societies in rural areas of the State.


Aarogyasri Scheme -There was presentation on Aarogyasri from Star Health. Some points gathered are given here:

921 procedures are covered including both surgeries and medical procedures

Some 10000 screening camps have been conducted. Specialists take part in these camps. Camps are not just for identifying candidates for hospitalization or surgery. Out of 17 Lakh persons screened only three Lakh persons required hospitalization.

Aarogyamitras liaise with patients and PHC at Mandal level and within Network Hospitals and patients. The premium was initially Rs 330 per White Card Holding family, average size being 3.4 persons. It was raised to Rs 390 in a later phase.

Even a new born child is included. There is an upper cover up to Rs 1.5 Lakhs per family (floater policy).

Nearly 85% of AP population is covered! Entire premium is paid by State government without availing any Central assistance.



This scheme covers almost all the points of the minimum requirements for senior citizens, particularly the following


· All BPL families are covered under the scheme with Health Insurance for 1.5 Lakhs on floater basis. There is a provision for additional 0.5 lakhs in special cases.

· There is no restriction on the size of family. Even great grand parents can be included

· All Senior citizens who are members of a BPL family are covered irrespective of their age and the pre-existing diseases.

· Now 942 different medical procedures are covered including injuries due to accidents..

· Recently 121 ailments have been added for which OPD treatment is provided up to one year

· Senior Citizens living alone are regarded as a family unit and are covered.

· The entire premium is paid by the Government of Andhra Pradesh



The only disadvantage in this scheme is that it covers only BPL families, though some

Exceptions have been made as in the case of journalists. We have to represent to the Government that the APL families should also be covered under it.


5.0]Cover of inmates of Old Age Homes under HI – Prof Vishweswariah observed that the Senior Citizen inmates of OAH usually do not have health protection. Most of the OAH do not have adequate facility or financial resources to provide quality health care to their inmates. It is therefore, imperative that State takes responsibility of providing them health security particularly to those belonging to BPL category. The administrative hurdles should be overcome with a firm determination.



6.0] Decisions (action points) of the meeting are:



1. APSCCON to approach the State government to extend Aarogyasri scheme to senior Citizens in APL category, on premium sharing basis. Star Health promised to get back after internal discussions. Prima facie they believe it is feasible.

The other alternative is that the APL families are covered on premium sharing basis. The senior citizen members of these families will automatically get covered. The senior citizens living alone should be regarded as family units and covered. Apsccon to take up this issue with the Government.



2. AISCCON to urge other states to replicate Aarogyasri scheme and cover both BPL & APL families/senior citizens.



3. The inmates of Old Age Homes must be provided health cover, under Aarogyasri in AP and under other suitable schemes in other States. It should be taken up as a priority demand in AP by APSCCON and at National level by AISCCON.



4. Banks to be approached to lend money for construction of Old Age Homes where the borrower has land for mortgaging.



5. To follow up with IRDA with respect to:

a) Implementation of Sastry Committee recommendations for the benefit of those Senior Citizens who can afford

b) Getting Clarification on two recent circulars about renewal of Health Insurance

Policies and increases in premiums.

b) Government giving a subsidy of Rs 100 per month to buy health insurance which will

supplement the senior citizen’s efforts to health insurance.

c) Tax Concession offered under Section 80D for Health Insurance premium to be

replaced as a rebate in Income Tax.



6. Family Clinic Concept to be popularized. GHMC who have set up 50 Day Care centres in the City may be requested to arrange attendance by a Doctor for one or two hours daily in these centres.

Mr. K.R.Gangadharan [who joined for part of the time] promised that Heritage Hospital will come out with a scheme strengthening Family Clinic Concept wherein a senior citizen can get an annual check up and monthly consultancy at an affordable fee.


The meeting ended with a proposal of Vote of Thanks by Sri Venkateswarlu.

As Reported by: Dr. P. Vyasamoothy - Vice President [APSCCON]