Healthcare challenges of the elderly: Insurance-based system has failed to meet their needs

senior citizens elderly

The Insurance Regulatory and Development Authority of India (IRDAI), has asked health insurance companies to abolish the age limit of 65 years and provide it to everyone, regardless of their age. This sounds to be a good decision.  The question however is whether insurance based healthcare system serves the needs of our citizens particularly the elderly.

The older age period of life is full of challenges. Both physical as well as mental capacities start facing a downward trend. With weakening of immune system the likelihood of falling prey to infections increases. Chronic degenerative diseases add to the problems of health. Some of the important and more challenging illnesses include Arthritis, Heart Diseases, Cancer, Respiratory Diseases, Cerebrovascular accidents, Parkinsonism, Alzheimer’s disease, Osteoporosis, Diabetes, Infections, and Depression. This period of life is a time when social connectivity decreases and loneliness ensues.

The India Ageing Report 2023 notes that by 2050, the share of senior citizens — aged 60 years and above — will rise to 20.8 per cent of the population. That is close to 34.7 Crore (1). 

In 2020, population aged 70+ years for India was 5.25 crore persons and population aged 75+ years for India was the 2.8 crore persons  (2).

Our country has to therefore chalk out strategies to meet economic and health issues of this group of population. Large number of population in this age group does not have its own earning. Chattopadhyay et al. in 2022, found that only ‘some 36% of older adults above 60 years are engaged in income-generating activities. Out of them a mere 5% have full-time jobs, and only 25% have documentary evidence of their current work’.  There are 92.4% informal workers (with no written contract, paid leave and other benefits) in the economy. Thus elderly who worked in the informal sector and have given up working now, have no pension and hardly any social benefits (3).

Under such circumstances they have to depend on their children to meet their needs. In some unfortunate situations the things get worse if the family is uncaring and neglecting the elderly. Elderly need compassion. They need emergency care – sometimes repeatedly. Healthcare for the elderly has to be designed accordingly with focus on palliative and rehabilitative care as well for all geriatric illnesses.

Several health schemes have failed to meet the health needs. Barring the CGHS, ECHS and ESIC all other schemes offer only a premium based limited coverage. These schemes including the Ayushman Bharat provide only hospitalization benefits. The OPD care is not covered. For day to day health care people have to visit the doctors in OPD and spend on medicines and investigations from their own pocket.

There are several conditions to be eligible to get the Ayushman card.  The people who are  not eligible  include those who have two, three or four-wheelers, own mechanized farming equipment, they are employed by the government, earn Rs 10,000 per month, they own refrigerators and landlines, they have a decent house, they have agricultural land and they have a Kisan card with a credit limit of Rs 50,000 (4).

As a result large number of population purchase the health insurance from the private or state owned companies. The premium for such insurance is quite high and beyond the reach of common citizens. For example for an insurance cover of 10 lakh rupees a person in the age group of 71-75 has to shelve for basic cover under New India Mediclaim Policy an amount of Rs. 57,024/- plus 18% GST. The outpatient treatment is not covered under this policy. It is not possible for vast majority to pay such high premium.

Therefore it is imperative that government owns the responsibility to provide universal healthcare to the people of the country. This is possible only if there is increase in the budgetary allocation to health to 6% of the GDP. It is unfortunate that the public spending on health  in our country is much below many countries. According to Indranil, Professor at the Jindal School of Government and Public Policy, O.P. Jindal Global University, Sonipat, Haryana in an article published in The Hindu on 15th May 2024, per capita public spending on health in India is only (25 $ PPP) Rs.2075/- in comparison to Bhutan (69 $ PPP) 5727, Brazil (347 $ PPP) Rs.28800/-, South Africa (352 $ PPP) Rs29216/- and China (363 $PPP) Rs.30129/- in the year 2021. Brazil’s health spending is 13% of GDP compared to 1.24% by our country. The Union Government’s  spending in India on health as percentage of GDP is only 0.28% compared to 0.96% by the states.

The global experience has shown that wherever state has owned and effectively discharged its duty towards universal healthcare, the outcome has been better as compared to those with privatised and insurance based healthcare system.

Dr Arun Mitra is a Practicing ENT Surgeon in Ludhiana, Punjab. He is also the President of Indian Doctors for Peace and Development (IDPD) 

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