Earlier this month, the country’s insurance regulator, the Insurance Regulatory and Development Authority of India (IRDAI), reiterated that insurance companies are required to offer insurance cover for mental illness, thus making treatment on a par with physical illness. While the Mental Healthcare Act, 2017, which came into force this May, requires insurance agencies to offer such coverage, patients, doctors and experts say little has changed on the ground.
“The IRDAI announcement comes at a time when mental health conversations are a part of mainstream dialogue. By reducing the economic burden, people with mental illness (in many cases, life-long) will now have the option of a more productive and integrated life,” says Dr. Ambrish Dharmadhikari, a psychiatrist with Mpower, a company that works in mental health diagnosis and care. “But the immediate ground reality of the high cost of treatment for mental health-related issues hasn’t changed for many just yet,” he adds.
Studies show that government spending on health care is ₹1,112 per capita, or only ₹3 per day for the health care of an average Indian. There are direct and indirect costs that patients and agencies must bear such as medications, hospital visits and hospitalisation.
The indirect costs involve intangible expenses such as loss of income from work and societal costs. Though direct costs are tangible and can be clearly elucidated, indirect costs are relatively difficult to be uniformly applied and vary across health systems. A World Health Organisation study (2015) shows that one in five Indians (or the equivalent of 200 million people) may suffer from depression in their lifetime.
Because mental illness requires prolonged medical attention, continuous care and support from professionals, it constitutes a significant financial burden. It is not uncommon to have people stop treatment mid-way (especially for women and even the elderly) due to increasing costs of treatment. “Importantly, insurance could stamp out any and all stigma associated with mental health, ensure dignity and stop discrimination,” adds Neerja Birla of Mpower.
“The math is simple to work out — cost of consultation, medicines, travel, hospital stay, reduced income from the person under treatment (who may be on leave or could be under-employed due to his illness), loss of income for the person accompanying the patient, cost of looking after the patient at home (nurse, attendants) and the escalation in health-care costs,” says Rosamma Jacob, whose husband has been battling depression for over 17 years now and has recently retired from a private firm.
She has heard of the IRDAI clause but is unsure of the details. “There are several areas that we would like clarity on. Does it apply to people who are currently under treatment? Is this benefit available to people who have another underlying health condition in which mental illness is a part of it? Which are the diseases covered? And, most importantly, for how long, as most mental health issues linger for a life time?” asks Ms. Jacob.
Dr. Nand Kumar, Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, says there are also a lot of administrative “blind spots” that need to be addressed. “Mostly, people (with mental health ailments) are out-patient department-based so we need to be clear if this scheme will cover that and again, for how long,” he adds.
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