This is the story of Munithayamma, a 35-year-old woman from Devanahalli village near Bangalore. She has no to formal education and her family is below poverty line. She is also a part of the dairy cooperative. Membership of the cooperative society automatically enrols her in the Yeshashvini Health Insurance Scheme while being a Below Poverty Line she is a part of Ra
sthtriya Swasthya Bima Yojana.
A few days ago, she approached us because of her acquaintance with MuneGowda.
She narrated her story: “I was identified for weak eyesight at the Lions Club Camp arranged in my village and received some eye drops. The blurred vision continued in my right eye. Three months ago, the dairy cooperative person had advised us to go to a reputed eye hospital in Bangalore using the Yeshashvini card. My son and I were insured at that time under Yeshashvini. We went to the hospital but the Yeshashvini help desk person asked us to get my husband enrolled in the scheme to avail benefits under the scheme.”
“We went back to Devanahalli and got our membership renewed adding my husband and the other sons name in the list. We again paid Rupees 150 each not only for them but also for the two of us. We came back to the same hospital after adding my husband’s name in the card. I was allowed to avail the services then and was examined by three doctors and was advised to wear a thick glass in the right eye.”
She assumed that the doctor had advised her to wear a thick glass in the right eye and she was afraid how she would look with glass only on one eye! How would people react and she was sure that they would laugh on her!
She narrated “ಡಾಕ್ಟರ ಹೇಳಿದ್ರು ಒಂದು ಕಣ್ಣಿಗೆ ಧೋಷ ಇದೆ ಒಂದು ಕಣ್ಣಿಗೆ ದೊಡ್ಡ ಕನ್ನಡಕ ಕೊಡುತ್ತೇವೆ.ಒಂದು ಕಣ್ಣಿಗೆ ಹೇಗೆ ನಾನು ದೊಡ್ಡ ಕನ್ನಡಕ ಹಾಕಿಕೊಂಡು ಊರಲ್ಲ್ಲಿಹೇಗೆ ಓಡಾಡಲಿ, ಅದಕ್ಕೆ ಬೇಡವೆಂದನು”. (doctors said you have problem in one eye and have to wear a thick big glass in that eye. How would I wear a big glass in one eye and go out in the village. That is why I didn’t want to wear that glass)
She added, “So I decided not to go for it. I told the doctor that I had a headache also and the doctor suggested getting a scan done but in some other hospital as they did not have those facilities.”
We asked her about the prescription but discovered she had not been given any! Then we asked which scan was suggested and which hospital but she says she was not told anything about that. She further added that the doctor had asked her to come only after that. She said that she didn’t know where to go and which scan was to be done. Her vision problem is also not cured.
She was totally lost and confused and believed that it was her fate that she would not be relieved of her pains.
“ಏನು ಮಾಡೋದು ಎಲ್ಲಿಗೆ ಹೋಗೋಧು, ಇದು ನನ್ನ ಹಣೆ ಬರಹ!” (I don’t know what to do, where to go, this is my fate)
We asked her to give us a list of hospitals empaneled under the scheme but she did not have that. She only came to the eye hospital because the dairy person had informed her that she could avail services under the scheme in that hospital.
This makes us think that:
- There is a need for improving the awareness of the scheme, so that the insured are able to use the benefits they are entitled to
- There is a need to communicate to the beneficiaries about the hospitals empanelled under the scheme and the type of services they provide
- There is a need to have more local people to help in improving the awareness of the scheme like the contact in the dairy
We went back to the eye hospital and retrieved her file. The attendant looked at the file and told her in Kannada that the doctor had written that she had to come for yearly checkups. She advised her to go back and return next year.
We intervened and explained the situation and requested to meet the doctor. They were very polite and helped us to do so. But this was not the same doctor that she had met earlier. The other doctor read the file and informed us that she had weak eyesight since childhood and right now it is very high negative power, which is incurable, and so we just advised her to wear safety glasses to save her other eye. Nothing was mentioned in the file about her headache.
The whole interaction raised several issues.
- What made her think that the doctor was asking her to wear a glass over one eye?
- What made her think that she needed a scan before coming back for treatment?
- Was there a problem in understanding the doctors language?
- Do we need a patient guidance centre in the hospitals that can help with the patients understanding doctor’s instructions?
- Can we bridge the knowledge gap between the providers and the community in health care?
- Can the doctors be better communicators?
We then went back to the Yeshashvini help desk to understand why they asked Munithayamma to get her husband enrolled when she was insured and needed services.
The help desk representative explained that they verified their records for the head of the family but that column was blank in their records and only she and her son were enrolled. They asked her husband to enrol as the head of the household column needed to be filled before verification of the records.
This raised the following questions:
- If the woman is insured and has the insurance receipt then why does her husband have to enrol as well?
- How did they insure her without writing the name of the head of the family?
- In this case if the son was the primary member, why did the insuring agency not put her sons name in the column of head of family?
- Was this a mistake of the family or of the people heading the programme?
- If they have insured the family without insuring the head of the family, why did she not receive the benefit?
The implications of such incidents are:
- The community has unmet needs and are not able to avail services even if they are entitled to do so
- Even after being insured they incur huge indirect costs just to avail services. In this case the BPL woman is spending Rs. 300 for insuring the two members of family, then again spending Rs. 600 for including other members and themselves in a hope to avail services. But again because of little patient support she ends up spending Rs 200 each time to reach hospital and her family member ends up losing Rs. 200 as wages lost every time she needs to go the hospital. And this is not a one-time expense. She had to visit the hospital thrice already. We do not know when this will end.
Health insurance initiatives have been taken up by the state and central government to reduce out of pocket expenditure. But we have to realize that we need to implement it properly and increase awareness and education about the scheme to achieve the objective.
Otherwise it is just changing the way of financing health care without achieving desired results.
Posted by: MuneGowda and Nehal Jain
(Photograph source: http://blog.seva.ca/?tag=eyeglasses)
