Health Insurance Scheme Generates Conflicting Opinions

An insurance scheme which has received the approval of the Government is attracting brickbats and bouquets. As many as 2.5 million households stand to benefit from the scheme which the ICICI-Lombard is meant to implement. But the scheme has come under criticism from some experts who contend that it will do no good to the poor while undermining the reasonably successful public healthcare system in the state.

Every year all households coming under the project can avail themselves of a maximum Rs.5,000 as outpatient expenses, Rs.30,000 for treatment in hospitals, and Rs.15,000 as hospital expenditure for every birth in a family.

The annual premium per family works out to Rs.399. But each family has to pay just Rs.33. The rest will come from the central and state governments and local bodies. Leading public health expert C.R. Soman said that the scheme was practically not feasible.

"It is sad our leaders fall prey to the tactics of companies promising the sky," he said. "The private health sector will take away most patients. The public healthcare sector will suffer. This is the desire of those behind the scheme."

B. Iqbal, a health educationist and a former vice-chancellor of the University of Kerala, said the scheme violated the basic principles of insurance. "The general practice in insurance is to share the risk. Under this scheme, the risk is very high for the company. There is a catch somewhere and only time will where that lies," said Iqbal, who is also a neurosurgeon.

But T.K. Jose, convenor of the official committee that formulated the program, said both the company and the Kerala Government were aware that the first year could see the company in the red. He also said that ICICI-Lombard had come up with the lowest premium quotations.

"We are confident the scheme will be viable because quotations from all nationalized insurance companies were high. The lowest rate from the public sector was Rs.542. The ICICI-Lombard rate was Rs.399”.

Jose, who heads a poverty eradication program of the Government, said the fears of experts were not valid since there were strict checks and balances in the scheme.

"We have prepared a detailed list of treatment to be administered to patients for each illness and it will be the same in both the private and public sectors. All hospitals violating these norms will be blacklisted," said Jose.

He added that the company would get free publicity since it would reach out to 2.5 million households.

"The insurers already have a scheme in Assam and have insured 3.5 million weavers across the country. Moreover, they are contracted to run our program for three years," said Jose.

But economist M.A. Oommen has warned "The need of the hour is to remove the structural anomalies in the public health sector. If this program is launched, in a very short period of time the public healthcare system in Kerala would collapse".

Edited IANS