Low awareness, poor implementation bane of BPL health schemes

Health insurance for the lower middle class and Below Poverty Line (BPL) families is still a mirage.

 For, most families believe that availing a health insurance policy is a waste of money. Perceptions might be changing slowly, but a large section of this population continue to struggle without any medical cover to meet rising health expenses.   

Mahadevappa, a senior citizen, suffered a major heart attack recently. He was rushed to the hospital immediately by his family members. Since they managed to get him to the hospital within the “golden hour” and ensured timely medical intervention, Mahadevappa survived. More importantly, the family could raise the initial amount of Rs. 70,000 sought by the doctors before they started the treatment. They knew the amount would be reimbursed, since they had a health insurance.  

It would have been indeed tough for a lower income or a BPL family without a health cover. Mahadevappa’s daughter Sujatha had this to say: “What would have happened if we did not have a health insurance. There are many families who have gone through such a situation, where lives have been lost.”

Keeping a certain amount every month for your family’s health is not a bad investment. It could prove smart since such an amount will come in handy at the right moment. However, health insurance experts are convinced that India has to go a long way in understanding the need for a health insurance policy.

 “People in India have a likeness for gold and they will invest any amount to have a piece of gold jewellry.  The poorest of the poor will have the money to buy gold, but when it comes to health, which is also considered wealth, the pockets run dry and is seen as waste of money,” says an insurance expert.

Areas ignored 

For the BPL families, the State government has introduced many health schemes to avail free medical treatment. But, these health schemes are not reaching everyone as there are still many pockets in the City denied even basic health benefits.

 Consider the case of Devarajeevanahalli, an area plagued by numerous civic problems that trigger deep public health issues for the residents. Name any disease or infection and this area has a patient suffering from it.  From malnourishment to typhoid to dengue, one of the families here has had to literally live on the streets when three members fell sick. The family could not afford to pay for their treatment.

According to Sylvia, an NGO volunteer, the situation has improved slightly but only after a public hearing. But people here are unable to get even basic medicines free of cost.

When Radha (name changed), a patient with cardiac problems visited a private hospital in the area, she was told she could avail of the facilities under a State-run health scheme. Still, she had to return without any treatment. Reason: She was told her scheme card was invalid. “I am not the only one. There are many of us who do not know what to do when such a thing happens,” she complains.  

Poorly designed schemes

Flaws in design, problems in implementation, gross overlapping of the benefeciaries and lack of proper grievance redressal systems are the major issues with the State health schemes, explain social workers who interact with beneficiaries often. “There are multiple layers of administration. Each of these schemes are implemented by different departments and agencies. Due to this, there is big confusion,” points out Akhila, a volunteer of the People’s Health Movement. 

The focus is mostly on existing diseases. “While importance is given to cure, there is hardly anything being done about primary and preventive care,” she observes.
 If the plight of residents is bad, it is  worse for migrant workers many of whom are attached to the Namma Metro rail project. According to Ekta, a volunteer from another NGO, due to the language barrier, these migrant workers do not go to the government hospitals. High costs prevent them from going to private hospitals even for basic treatment. “Many just go home when they are ill and come back when they recover,” explains Ekta.  

Central and State health schemes suffer from a problem of awareness. Lakhs could benefit in theory, but there is no concerted effort to let people know that such schemes exist. The government did consider empanelling the private sector to bring in more people. But private hospitals withdrew support citing prevalence of fraudulent BPL cards and rising costs.