Mental Health

How is the Mental Health Insurance Coverage in India?

MedPiper Technologies and JournoMed covered a panel discussion of Schizophrenia Research Foundation (SCARF) conducted on 28th June, 2022, that addressed topics on Mental Health Insurance and Coverage.

Dr R Mangala, Consultant Psychiatrist and Assistant Director of SCARF (I) and Mr A Chiranjeevi, MPH Research Assistant, SCARF (I), were the moderators of the event. They briefly touch on Mental Health Insurance and whether its Exclusive or Inclusive. Dr Mangala also spoke about the importance of National Insurance Awareness Day and the Significance of Mental Health Insurance in recent times. This panel discussion covered various other topics such as:

  • How is mental health insurance beneficial to both the customers and the stakeholders?
  • Are insurance companies providing the Mental Health Insurance for the Mentally Ill individuals?
  • How far Mental Health Insurance are applicable in India and in other foreign countries?
  • The Role of SCARF in promoting the need for insurance benefits for mentally ill individuals

To better understand the scenario of mental health status of India, NIMHANS conducted a National Mental Health Survey in 2015-2016. The survey found that that over 80% of the population suffer from mental health disorders, either substantial or anxiety disorders and most of them don’t have access to the treatment. The lack of educational awareness and social stigma are the common reasons as to why most people don’t opt for treatments. High and sometimes, unaffordable cost of treatment as well as the difference in costs from public to private hospitals also hinders people from seeking the requisite treatment.

Dr Chiranjeevi provided a rough idea about WHO’s statistical data on medical expenses (out-of-pocket expenses) that are incurred globally. He explained that most of the expenses go for travel and intangible expenses. Dr Meenakshi, Consultant Ophthalmologist, spoke about the trauma that individuals with mental health issues suffer from and how the supporting family members struggle in claiming mental health insurance.

Mr Sanjay Pinto, Advocate, Columnist, Author and Former Resident Editor for NDTV 24/7, spoke about the Mental Health Care Act and the role of Insurance Regulatory and Development Authority (IRDAI) in enforcing this act. The IRDA had issued a circular to ensure that anyone from any background can obtain appropriate and affordable treatment for mental illness. IRDA should supervises the functioning of the insurance companies to ensure that no discrimination is met out to those who seek policy coverage especially for mental health illnesses.

Important aspects of mental health insurance include:

  • As per fundamental provisions, timely medical aid is essential for any individual
  • The individual must ensure that proper hospitalization is provided in case of any emergency.
  • Any individual has a right to claim insurance if hospitalized.
  • Proper care must be provided for patients with severe mental health conditions and for those who have suicidal tendencies.
  • Proper hospitalization is recommended for patients who suffer from mental illness or other psychiatric conditions.
  • A basic insurance policy must have all the relevant information and the agent must clearly explain all the policy terms to the patients.
  • Hospitals cannot claim itself as a super-speciality or multi-speciality centre unless it caters for the needs and treats the important facet of health i.e. the mind. These hospitals do not possess the rights to even advertise themselves as a super-speciality or multi-speciality until then.
  • A family on average needs 5-10 lakh rupees for insurance and there are only a few insurance companies that cater for the needs of individuals in risky times. The insurance companies must maintain transparency and explain to the exclusions to the customers very clearly.
  • These insurance policies must be citizen-friendly, patient-friendly and customer friendly. Insurance is a necessity today including for those who suffer from mental illness.
  • Everybody must be aware of mental health. From April 2021 onwards, it is necessary that all general insurance policies must cover mental illness.

Insurance itself comes as a package deal in India. Every state must promote mental health as a part of public health. An initiative must be taken to ensure that the insurance policies are easily available to the common citizens.

The Scenario of Mental Health Insurance in India from other countries

Ms Narjis Hussian, a freelance writer from New Delhi spoke about the scenario of Mental Health Insurance in India in comparison to other countries. She said that in India the main drawback is that health insurance lies in the private sector except for Ayushman Bharath. Ayushman Bharath Rural and Urban is only meant for Below Poverty Line families and not for the general public. It only covers mental illness treatment for patients hospitalised in government hospitals and not for those admitted to private hospitals.

In America, there are two major medical health insurance policies, Medicaid and Medicare and both are applicable for all citizens. Children have a separate policy available called the Children Health Insurance Program (CHIP). Apart from these, there are two other health care programs which are Tricare and VCARE meant for military staff. All of these health insurances cover mental health, IPD, OPD, consultancy, medical diagnosis, hospitalization, rehabilitation etc.

In the UK, the National Health System is meant for all and covers all the illnesses both physical and mental. As these are developed countries, they are aware of the value of mental health and its connection with physical health. People here are termed as assets so they spend more on public health than in India.

Ayushman Bharath is a good initiative but it is not meant for each individual in the country. There is a significant line drawn between the government, health insurance and the public sector. The government should take an initiative for promoting public health and they should tie-up with the insurance companies for private sector.

Dr Mangala stated that the treating mental health issues is a long term process that goes on for months or years. As these treatments are considered expensive, most people suffering from mental health illnesses don’t opt for it.

The role of SCARF

Schizophrenia Research Foundation (SCARF), India, is a mental health centre and non-profit organization based out of Chennai that offers multi-disciplinary and comprehensive range of psychiatric care and rehabilitation services. It was established in 1984 by a group of mental health professionals. The organisation took the responsibility to work on mental health issues and provide insurance for people suffering from mental health illnesses and other psychiatric disorders.

Ms Hussain said that awareness must be created to bring in the support of the government executives and the media needs to play an active role in spreading it. She pointed out that it is the prime duty of the media to bring necessary attention to the policy issues, mental health-related program issues and allocation of the budgetary role. This awareness must also be spread among the masses to get rid of social stigma.

Conclusion

Mr Pinto brings home the necessity for enforcing strict laws to ensure that people with mental health issues get insurance. If one does not get the insurance, they can sue the company for violating fundamental rights. These insurance companies are governed by IRDA which is a statutory body having rich jurisdiction in the high court. The person who gets the insurance must get at least some relief even if the full amount is not covered. Thus it can be beneficial to mentally retarded individuals and supports them morally and financially.

Show More

Related Articles

Leave a Reply

Back to top button