Insurance becomes a hurdle

Government health insurance schemes have made life more difficult for the rural poor, finds Aparna Pallavi

By Aparna Pallavi
Last Updated: Sunday 07 June 2015

Sexagenarian Mohammad Shabbir, a resident of Kondapur village in Andhra Pradesh's Medak district, is always wary of visitors. “Your Arogyashri people are playing tricks on me,” he tells me, his voice sounding anxious. “They first asked for Rs 2,000, and when I sent it, they started sending me all sorts of stuff. First they sent me glass slides from the hospital, then they started sending me books!” Arogyashri refers to the state-sponsored health insurance scheme, which offers an annual cover of up to Rs 2 lakh per family.  

When Shabbir’s son brings out the bag containing the “books”, they turn out to be copies of the popular magazine, Readers’ Digest. The “glass slides” turn out to be a set of designer glass coasters—probably a free gift with a subscription. The “papers” are more junk mail from the same source.

Confusion follows. What letter did he reply to, and to whom did he pay money?  “While being treated under Arogyashri, I had been told I will receive a letter. When this letter in English arrived in a nice envelope, I thought it was from Arogyashri, and sent the money,” says a now sheepish Shabbir among hearty guffaws from his friends. 

Shabbir’s mistake does not reflect on the Arogyashri scheme per se, but it does tell something about the gaping urban-rural divide, which the poor have to make sense of before they can access healthcare through Arogyashri. In Shabbir’s village, no one can read English—the educated young have moved to cities. People later explain that for almost two years Shabbir was tense about the onslaught of the books, papers and slides, fearing some legal or administrative complication would arise from them.

Shabbir’s extreme case apart, the urban-rural divide can hit unsuspecting rural people. Arogyamitra (health worker) from Kondapur public health centre (PHC), D Ashoka, is eager to show off the case of eight-year-old Shravani in the neighbouring Thogarapalli village as a success. Shravani has been operated on for a congenital heart problem. But Shravani’s mother Anitha bursts in with a seemingly unrelated complaint. “Why couldn’t they put us in a less posh’ hospital?” she asks.

Anitha and her husband from Thogarapalli village in Medak district had to spend Rs 30,000 on food and commuting during the 26 days their daughter Shravani was hospitalised in the posh Banjara Hills in Hyderabad. Anitha would have preferred her daughter to have been treated at a less posh hospital nearer home

Inquiries revealed that Shravani had been sent to Care Hospital, located in the uptown Banjara Hills. “We knew no one there, the hospital had no canteen and there were no ordinary hotels around,” says Anitha, while adding that one meal cost Rs 100 or more there. “They also do not allow us to stay in the hospital with the patient.”  In the 26 days of Shravani’s hospitalization, Anitha and her husband, who supports three children on an income of Rs 200-300 a day from driving an autorickshaw, ended up spending more than Rs 30,000 on food, stay and commuting. “Shravani is much better since the surgery, but we could have saved the extra expense if we were sent to a hospital closer home,” says her mother.

Post surgery trauma
T Jangaiah and T Mallesh of village Malkapur close by, both landless labourers, are stuck with post-surgery complications, and don’t know where to find redressal. Jangaiah, 60, has developed a huge painful lump, resembling a keloid, at the site of the scar from his bypass surgery. Mallesh, 25, underwent surgery for fractured facial bones, but afterwards felt excruciating pain in the operated area and the vision in his right eye became distorted. Both, however, were told by the respective hospitals where they were operated that nothing could be done. Mallesh had to shell out  Rs 28,000, loaned by a money-lender, for a second surgery which eased the pain. He continues to suffer from distorted vision. Jangaiah suffers in silence because his family already has a debt burden. “I am breathless all the time from the heaviness caused by the lump, and can’t eat or work,” says he.

Jangaiah, 60, has developed a huge painful lump, resembling a keloid, at the site of the scar from his bypass surgery. The insurance does not cover post surgery treatment. He suffers in silence as his family is already under heavy debtBoth have received a packet of papers from Arogyashri after they underwent their respective surgeries, which contained a blank self-addressed inland letter card from Arogyashri for feedback, but it has never occurred to either of them to use it  to voice their complaints.

“The scheme is targeted at the poor, but not tailored to their needs and hurdles,” says Rajan Shukla, associate professor, health care quality, at the Indian Institute of Public Health in Hyderabad. “The scheme does not have any follow-up system to check if the surgeries which government is paying for have really benefited the patients, whether their work-capacity has been restored to earlier levels. Instead, the onus for providing such feedback has been put on the rural poor—the bulk of Arogyashri beneficiaries—who are neither educationally or temperamentally equipped for it. For all you know, thousands or even millions of such patients may be suffering in silence while private hospitals fill their coffers and government congratulates itself on having successfully addressed rural health issues.”

What people want
And what does one say of people like J Ramalu, a manual labourer from Kondapur, who spent Rs 16,000 on treatment of fever, which turned out to be a combination of typhoid and malaria, at a private hospital? “I was denied Arogyashri because I did not need a surgery,” says he. “So what could I do but take a loan?”

Finally, what do the rural poor need by way of health care? “I will tell you what we need,” says K Veerappa. “We need a hospital close by, where we can go and get treated for everything from ordinary fever to big problems. We don’t want to know what scheme we are being treated under, and we don’t want to be burdened with papers. And if the treatment does not work, we want to be able to go back and get treated again.”


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  • Yes, it is true that

    Yes, it is true that Arogyasree Health Scheme is creating hurdles for people. People's healthcare expectations are justified. Hospitals should be accessible without restriction on type of diseases. Why should there be restrictions or treatment of selected diseases? Once a person is insured for health, then every type of disease should be covered.

    This selection of diseases confuses people who first have to find out if they are eligibile and then made to to run from pillar to post. Other disadvantage of such selection leads for mismanagement of the guidelines, both by the service seeker and provider.

    For better healthcare, these are my suggestions:

    -Make simple procedures and improve accessibility

    -Don't treat diseases selectively

    -Minimize the stigmatization of the card holders and
    make them aware for better utilization of benefits

    Hope, these measures will help for the better utilization of the health schemes, conserving the health and wealth of the needy people.

    Posted by: Anonymous | 8 years ago | Reply
  • How do these insurance

    How do these insurance companies feel like making life hard for people in the rural regions? It is indeed very cruel of them to do so. Anyways I hope the government involves and sort out these problems. Thanks for sharing the news.

    Posted by: Anonymous | 7 years ago | Reply
    • The government doesn't give a rat's ass about what happens to poor people all they can do is launch these schemes which become another source of corrupt income for the govt officials and employees involved in the schemes.

      What if shows is that we as a country are totally unconcerned about how things work and how they should. It is surprising that it seemed the whole nation was out to end corruption and supported modi for the promises he made during campaigning. The achhe din have come, I mean it seriously. Midi never said kiske achhe din he said achhe din aayenge and he was right. Midi me achhe din Hain, Amit Shah aur uske bete ke Hain, bjp, rss aur vhp walon ke achhe din hain aur jo bhi gale mein gerua dupatta latkale uske bhi hain.

      Adani me achhe din Hain ki 3000 crore pebble liye they bank we Karzai who to site nahin aur 6000 crore ka Maya loan mom gaya. Anil aur mukesh Albany ke achhe din hain ke 1225000 crore jo inhone aur Kareeb 66 aur arabpatiyon me bank as liye hue Hain who dene nahin pad rahe aur phir bhi dassault india pvt ltd. Ke ceo anil ambani hain, adani ki power company bhi ban gayi aur gas company bhi ban gayi. Arhar dal bhi adani late melange rate par, Anil Albany ki but power company bhi hai, aur crude oil ka rate $23 talk for me par bhi modi ne rates jam nahin liye aur kaha oil companies apna loss bacha lengi isliye jam nahin karte. 2014 we pebble crude ka rate $109, $114, aur was pass the par diesel aur petrol itna mehanga nahin the kitne aaj hai $60 ya issue those she's a hai crude ka rate.

      Hindustan ka sabre bada scam 2g aur 3g nahin, na hi coal scam hai, sabre bada scam Narendra Modi hai.

      Gujarat model ke ma'am par was man me in pahuncha Diya Modi no jabki unki party ki hi leader ne sachchai Bata di ki koi development nahin hai Gujarat me sort kagazon mein dikhaya gaye Modi ko bada banane ke liye. Uma bharti me to saaf kaha hai on sab booth hai bol ke niche sabre jam log Gujarat me in Hain ye bhi jooth, bijli panel aur sadkein Hain her jagah ye bhi, aur Kya chart ne to naam bhi sahi Diya tha on ye vikas purush nahin Vinash purush hai.

      Agar Gujarat time developed the to Abhi election we pehle 65000 crore ka package kyon Dena pad raha hai, sadkon par barish ki wajah se flooding kyon ho rahi Thi??

      Aur iska karan hum hain jo corruption khay karte on Bata karte Hain aur uske basis par sarkarein badal date Hain par jagah also corruption hai wahan karte Hain ki ma'am to tab hi hoga jab rishwat doonga aur rishwat dekar apna kam kara lene ke bad phone sarkar ko aur netaon ko beiman Bata aur gali dete hain aur kehte Hain ki sab chor Hain.

      Ye bhi jaante Hain ki sarkaar to aati jaati hai par sarkari mulazim 30 saal ya thoda upar neeche rahte Hain aur wohi Hain jine hum paise dekar ma'am kara raha hain to corruption kaise khatm hoga corruption jab hum hi chalate rahenge?

      Posted by: Shantanu | 2 years ago | Reply
    • The govt is not a single person not Modi but includes govt employees and us because we are supposed to make sure things happen the way they should and government employees and netas are answerable to us as they are there to protect and safeguard our interests not their own. But when people will continue paying bribes and telling others to do the same warna kaam nahin hoga, why won't the govt employees take it when we are giving it to them on our own but no one out of 1.3 billion people in India can make a stand where it is our life on the line. They hardly get time from vandalizing malls, protesting about films and causing a riot or blocking the roads over stupid and trivial things like movie but will not have the guts to stand up against corruption because "you can't change the system" the system is me and you and everyone around us and change is the only constant in life like death, inevitable yet we don't realize this strength.

      Posted by: Shantanu | 2 years ago | Reply