Why don't our poor know about health schemes

There’s something daunting about public hospitals. Perhaps it’s the sheer scale of things: the massive buildings with numerous floors, corridors and lifts; the mob of bandaged and limping people, on stretchers and in wheelchairs; the flurry of white coated doctors, nurses and others going about their business. Public health institutes are a microcosm of India, and panic is the first reaction when you first enter one of them.

But once the fear of negotiating one’s way through what appears like a maze dies down, matters fall into place. I discovered this recently, when I accompanied a household painter we’ve known for 25 years to Safdarjung Hospital for some medical investigations. Chest pain had driven Syed to the emergency ward of this hospital in January. An angiography was recommended, but the machine had broken down. So Syed just swallowed pills to overcome the feeling of constriction in his chest and went to his hometown to rest.

Six months later, he was back in this city, but reluctant to tackle the public health system alone. Being illiterate was the biggest hurdle, since he couldn’t manage the paperwork.

I volunteered to help out. Altruism aside, I was curious to learn more about the public health system. Is it really as dismal as it is made out to be? The first step was an OPD consultation with the cardiologist who had treated Syed earlier. This was easy enough. We got a card made, and waited for our turn with 50 others. The atmosphere was congenial – everyone was united by the misfortune evoked by poor health.

A guard called out names, and people were let into the specialist’s room in twos and threes. The cardiologist was patient and respectful with everyone. He advised some tests for Syed, which would be done in the department of nuclear medicine. The medicos in charge of the tests asked Syed some questions about his lifestyle, eating habits and chest pain. “Wear loose clothes and come on an empty stomach,” said one, handing him a form with the date, instructions and a stamp for 4,000 rupees . “Payment can be made before the tests,” instructed the doctor.

Now Syed is a daily wage labourer with a family to support. 4000 rupees isn’t a small sum for him to rustle up. And this is just the beginning: what happens when arterial blockages are discovered and lakhs are required for stenting? Anyone in his situation, faced with a chronic disease, needs to figure out the economics of the scenario right at the start.

I discussed the situation with an official from the Ministry of Labour and Employment in the MIS wing of the hospital. “Treatment here is highly subsidised Madam,” he said. “The only way it can be waived completely is if a patient has a BPL card.” Free treatment was also available for a destitute, he said, but a certificate of proof was required.

Other options were to obtain a “low income certificate” from the SDM court or gain access to the “National Poor Patient Fund.” But the best option of all turned out to be the Rashtriya Swasthya Bima Yojana, a health insurance card for BPL families. Launched in 2008, this government scheme provides health insurance coverage of up to 30,000 rupees a year for BPL families. Each family is issued a biometric-enabled smart card containing their fingerprints and photographs.

But here’s the bad news. Barely a handful of the poor know about this. Like most other government welfare schemes, the RSBY has continued to remain buried under some bureaucratic file, reaching only a handful of those in need. Despite being hailed as one of the best insurance schemes in the world by the World Bank, ILO and UN, less than half of the so called BPL families were enrolled for the RSBY scheme at the end of 2011.

Perhaps the focus needs to move away from “overhauling” the public health system to educating and enabling the underprivileged about this and other national welfare schemes.