Insuring the health of our seniors

To stay or not stay insured is a dilemma confronting thousands of middle-class senior citizens after a public sector insurer doubled the premium for medical insurance. Not only has the premium been doubled but also discounts like family discount and bonus have been done away with.

The irony is that some private insurers offer cheaper policies but it is problematic for senior citizens to switch over to these insurers as many of them may have a pre-existing disease or health condition.

The Indian Constitution mandates that the state should provide public healthcare, but the government is nowhere near this objective. As far as the percentage of population having access to health care is considered, India ranks lower than Pakistan.

In its recent Union Budget, the government attempted an ambitious national health scheme. However, the jury is out as to whether the new health policy is a game changer or not.

At least, a beginning has been made which indicates that the government is thinking of the bottom 40% of the population. Unfortunately, politicians are not interested in the middle-class salaried lot as they do not constitute a vote bank. At best, they get lip sympathy.

Vulnerable lot

Senior citizens belonging to the middle class are a vulnerable lot. Primarily, I am referring to those who have retired from private sector jobs. Their counterparts in the government sectors and armed forces get a monthly pension and are covered under the medical schemes of their erstwhile employers.

The misconception is that a private sector employee gets a lucrative package. But the much spoken about crore packages with perks thrown in are limited to a minuscule section. Retired private sector employees neither get pension nor do they get medical reimbursement from their ex-employers.

As part of his/her retirement planning, a prudent person would have opted for medical insurance. It may also be noted that insurers have the freedom to increase the premium every three years. However, the sudden steep hike in medical insurance premium has come as a rude shock.

Furthermore, senior citizens are mostly dependent on interest income from fixed deposits. But with falling interest rates and rising inflation, the hiked insurance premium  is likely to burn a hole in their pockets.

Trust betrayed

Many of the senior citizens I spoke to complained that they had been with their public sector insurers from the past 20 years and they were now being let down in their twilight years.

A majority of them had not even claimed from the insurers during their younger days. Private insurers are late entrants, so perforce one had to take a policy from the public sector.

On the other hand, the high claim ratio over 100% of late is making a dent in the balance sheet of the insurers. After all, they are not charity organisations, so perhaps they have no option but to hike the premium.

Insurers in the recent past used to grant wide cover under the group policy issued to corporates. It was almost a case of individuals subsidising the group. Barring some exceptions, perhaps, this trend of wide coverage to groups is now limited.

One of the main culprits for high claim ratio are hospitals. In our country, there is no regulator for hospitals, which charge according to their whims and fancies. In fact, some tend to charge more if the patient has medical insurance.

A lot of unnecessary procedures are performed, too. It is a common refrain that hospitals are eager to perform hysterectomy for women over 45 and bypass for men over 45.

Caught between the hospitals and the insurers are the insured. We need an out-of-the-box solution to ameliorate the problem being faced by middle-class senior citizens. Any health insurance programme should be viewed more from a social angle than from a purely commercial point of view of selling policies which only the rich can afford.

Perhaps, the Insurance Regulatory and Development Authority of India (IRDA) can think of a health insurance pool similar to what had been done for third-party motor insurance.

Time has come for wise men and women of the many think tanks to devise ways and means to ensure that our senior citizens do not become financially dependent on their relatives and are able to live a life of dignity and respect in their sunset years.