A Blog for Senior Citizens by a senior citizen. Most posts are written by me and others are relevant news items. Emphasis on India. As posts could be made in quick succession, please see the Index (Archive) to see earlier ones. If you comment I won't lament.
CONCESSIONS AND FACILITIES GIVEN TO SENIOR CITIZENS
M.V.Ruparelia
(as of May 2011)
Part 4: Healthcare
19. Action by Ministry Of Health & Family Welfare: i) Ministry has formed a National Programme for Care Of Elderly during 11th Five Year Plan, which comprises- National Programme for Health Care of Elderly (Main Scheme) and development of National Institutes of Ageing with a total allocation of Rs 400 crores during Plan Period. ii) Major activities proposed under the main scheme are as below:
A) Development of 30 bedded health care units for Elderly Persons in 25 Medical Colleges in the Country. B) Development of 10 bedded Geriatric Units at District Hospitals in 100districts of the Country @ 4 districts attached to each Medical College. C) Development of Physiotherapy Unit at all the CHCs falling under 100 Districts. D) Weekly once OPD for Elderly and arrangement for Health Melas at the level of PHCs. E) Involvement of ASHA at Community Level. F) As regards the NIAs, these will be the apex referral institutes of the Country with 200 beds facility. Basic aim of these institutes will be development of specialized manpower, research in gerontology and patient care.
G) Health Ministry has started accreditation of Hospitals and Health Providers to ensure better medical service to Senior Citizens. H) Director General of Health Services has carried out projects on training of health manpower as well as developing training modules on geriatrics for different health functionaries for the purpose of providing training. A survey was conducted to find out the burden of diseases among geriatric population & the Report has been published in 2007.National Programme for Health Care for Elderly, approved by Ministry of Finance in June, 2010 has been notified with operational guidelines on their Web Site. A few meetings of stakeholders have been convened for finalizing the implementation strategy. Funds are released to Regional Medical Centres & States. I) Free of cost health services are already being provided to all Below Poverty Line (BPL) citizens including Senior Citizens. J) The Policy for providing land at subsidized rates for construction of private hospitals & charitable trusts already exists. K) As regards provision of geriatric wards in all the hospitals, article 20 of
`` Maintenance and Welfare of Parents & senior Citizens Act, 2007`` directs the State Governments to provide beds for all senior citizens as far as possible. Under NPHCE, there is provision for developing 30-bedded geriatric wards in 8 Regional Geriatric Centres and 10-bedded wards for Senior Citizens in 100 District Hospitals during 11th Five Year Plan. L) There is a proposal in the NPHCE to provide training to the Community Members in geriatric care by ANM at sub-centre level. Ministry of S.J. & E. is also taking care in respect of the training of geriatric care givers. M) One of the important components of NPHCE is information, communication and education. Strategy will be devised to increase awareness of the community in respect of the role of balanced diet, proper exercise, yoga etc in prevention and control of diseases. Mass media programme will be framed to increase the awareness of the public as well as the medical care givers on the various provisions being provided under NPHCE. N) NPHCE will provide funding for research programme which will include all the important geriatric problems including Alzheimer disease. Apart from this, the mental health problems are being taken up separately through a dedicated National Mental Health Programme, which will take care of elderly also.
20. Central, some States, some Municipal and some Private Hospitals give free or concessional treatment including pathological investigations. Many Trusts, Organizations, Lions` Club, Rotary Clubs, Associations etc arrange free/concessional camps, lectures, counseling, supply of required medical equipments free or concessional rate etc. Many Chemists give concessions in medicines. Large number of Organizations has come up with alternative Medical Care Systems like Ayurved, Homeopath, Yoga, Acupressure, Reiky etc etc free or at a cost.
21.National Insurance Company has introduced Varishtha Mediclaim Policy for Senior Citizens between 60 to 80 years EXTEDABLE UP TO 90 YEARS with a basic cover of Rs 1 lakh covering Hospitalization & domiciliary hospitalization and Rs. 2 lakh for critical illness. It shall cover pre existing diseases after claimless 1 year. Many other Insurance Companies also offer various schemes for Health Insurance.
22. IRDA (Insurance Regulatory & Development Authority) has accepted several recommendations of the Committee on Health Insurance of Senior Citizens (Shastry Committee) in January, 2009 and these are under examination & implementation by Finance Ministry.
My comment on the following news item: Heritage Hospital in Hyderabad is having a similar Senior Citizens Club for a long time but we get to hear about it during once a year cultural program only. Some private hospitals like Kamineni & Yashoda gave senior citizens cards, allowing certain discounts on diagnostics and treatment some years ago but such cards did not pick up. I do not know why.
=============================== Senior citizens health club
Staff Reporter COIMBATORE: Sree Abirami Hospital has started Abirami – Senior Citizens Health Club to extend benefits to the elderly.
A release from P. Periyasamy, Medical Director of the Hospital, said the scheme offered many privileges to those above 58 years at a nominal registration fee.
At present, the Hospital planned to enrol 1,000 persons as members.
Those enrolled would get two free consultations a year, concession on professional charges, nursing, room rent, investigation, diagnostic procedure, etc. priority in all services, the assistance of a special help desk and benefits of a periodical awareness programme.
Please read this new. Our important demand on the Protest Day for a separate ministry for senior citizens is getting echoed everywhere. Good Sign. Vyasamoorthy
Call for national health policy for senior citizens
Staff Reporter
— Photo: S.S.Kumar Adviser to the president of FICCI P. Murari presents a certificate to a volunteer of Dignity Foundation, at a function in Chennai on Wednesday. K. Radhakrishnan (right), Director, Dignity Foundation, Chennai and S. Sundaresan, Executive Director, Star Health Medical Insurance are in picture.
CHENNAI: Speakers at a function organised here on Wednesday to celebrate World Elders Day called for a well-defined national health policy and setting up of a separate department for senior citizens in the Ministry of Social Justice and Empowerment.
Advisor to the president of FICCI, P. Murari, who was the chief guest, said in most of the Scandinavian countries and the U.S., a lot of safety and security measures are in place for the elderly. "The government at the State and Centre must have a separate department for senior citizens in the Ministry of Social Justice and Empowerment to look after the welfare needs of the elderly," he said.
On the need to get sensitised on dementia, Mr. Murari said there is the need to train more nurses who are ready to take the patient through the day. He said more organisations should start geriatric wing and gerontology.
K. Radhakrishnan, Director, Dignity Foundation, Chennai, said the aging population that is growing at 7 to 8 per cent every year is one of the main challenges for the country. The National Dementia Summit held recently showed that 3.7 million senior citizens are affected by it. "Of the six lakh elderly population in Chennai, 25,000 have dementia," he said. Their is no social security for senior citizens in the country, but if every State implements the Maintenance and Welfare of Parents and Senior Citizens Act, there is hope for the elderly, he said.
S. Sundaresan, Executive Director, Star Health Medical Insurance, said the department for senior citizens should be headed by a person above 55 years as he/she would understand the needs of the elderly better. A.R. Sreeja, General Manager, Dignity Foundation, Chennai, read the annual report and highlighted the various services offered by the Foundation. Senior citizens who volunteer in different services run by the Dignity Foundation were honoured.
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
Participants: List is attached
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 Samantmade 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.Mahaptrasupported 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 Visweswaraiahread out four demands from his paper.
Sri Venkateswarlulamented 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 CurrentHealth 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 shouldbe modest and shouldnot keep increasing with age
·There should be no entry agebar 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 shouldbe 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 onthis 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-conditionswhich 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 tothe 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 NetworkHospitals 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 – ProfVishweswariah 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 withIRDA 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 HeritageHospital 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.
R.N.MitalDr. P. VyasamoothyProf. V.Vishweswraiah
ConvenerVice President [APSCCON]Secretary [APSCCON]
