A LAST WISH OF ELDERS IN INDIA
By Sanjay Pinto

You can get a pizza delivered in India within 39 minutes, or it’s free. You can have groceries left at your doorstep in 15 minutes. Or biriyani in about half an hour. But you seldom get medicines from even the pharmacy down the road, despite ‘Free Home Delivery’ boards, as most chemists are short staffed and your order is attended to only when they are free. So life saving medicines can be popped like chewing gum or cookies, anytime it’s available! Your SOS for an ambulance will also not be met earlier than 15 to 20 minutes. That’s if you’re lucky and traffic isn’t chock-a-block  and other motorists perform a supreme sacrifice of responding to the blaring siren and making way. A friend and former senior colleague at NDTV, who suffered a heart attack in Bengaluru a few years ago, decided to not wait for the ambulance but drive himself to the hospital, clutching his heart in almost filmy style. Providentially, he made it to the hospital but collapsed in front of the gate. The security guard noticed him and had him wheeled inside the ICU. My friend recovered. Had he waited for the ambulance to reach in Bengaluru’s notorious traffic, he wonders if he’d be alive today.

Senior male patient sitting on bed looking out window in room of hospital

That we as a nation get our priorities wrong is no secret. But when it could make a difference between life and death, it’s worth sitting up and taking notice. The worst hit are senior citizens who can easily get the medical help they need  in the comfort of their homes. But Big Brother – medical insurance companies will have none of it. Almost. In the pages and pages of ‘Exclusions’, the most prominent banned item is Domiciliary Treatment or Home Health Care. By the time this magazine is in your hands, the world will be observing Elders Day. A Report of the United Nations Population Fund and Helpage India estimated the population of senior citizens in India as 90 million in 2011, which could shoot up to 173 million by 2026. To break that down, our parents or grandparents constitute roughly 10 to 12% of our population. To further simplify this figure, 1 in every 10th Indian is a senior citizen. One third of this number live alone, with a spouse no more, and either abandoned, or their children live abroad. Meagre pensions or post retirement assignments keep their home fires burning. A medical emergency, which is most expected at that age, would inevitably wipe out whatever little savings they have.

How does our elected government abide by a Directive Principle of State Policy to promote public health under Article 47 of the Constitution of India? By allowing medical insurance companies to make it impossible or extremely difficult for senior citizens to get fresh mediclaim policies after they touch  65 years. By making premium prohibitively expensive, often out of the reach of pensioners. By letting insurance companies insert clauses like ‘no claims’ for one or even upto 4 years of starting the policy. By appointing a toothless cat like the IRDA (Insurance Regulatory Development Authority) which stuck in a Mohamed Bin Tuglaq mindset, frames ridiculous exceptions to the ‘No Domiciliary Treatment’ dictum like inability to transport the patient to a hospital and non availability of  beds or rooms in a hospital. In this age of air ambulances and hospitals mushrooming everywhere, these rules are a cruel joke. Medical insurance is based on the principle of ‘uberrimae fidei’ or utmost good faith. In practice, these companies seem to  follow the principle of ‘minimise claims, maximise premium’.  What else would explain this holy grail of the minimum 24 hour hospitalisation norm? And either way, you are damned with these blokes. The insurance representatives will stand like referees holding stop watches to deny claims if a patient is discharged even 5 minutes less than 24 hours. Or they will question the need for hospitalisation. A friend was shocked when her insurance company even questioned the quantum of pain killers used for a medical procedure! As if a strait jacket formula can be used for something as relative as tolerance to pain.

The fact is that no one wants to ever get hospitalised. No one wants to stay a minute longer in a hospital and acquire new infections. For that matter, no one wants to even ever have to use a mediclaim policy. But when life throws lemons at you, insurance companies will insist that you drink electral only on a hospital bed. Venturing into the insurance company – hospital nexus will rip open a barrel of worms and that’s for another column. But it’s about time that the concept of Home Health Care is recognised and not demonised  in mediclaim policies. Because health can be where the home is.

Sanjay Pinto Black Shirt

(Sanjay Pinto is a Lawyer, Columnist, Author, Mentor – Silver Tongue Academy Resource & Former Resident Editor – NDTV 24×7)