Poverty and Healthcare

Overview:

Poverty undoubtedly plays a role in an individual’s health status. The blog explains the effects of poverty on healthcare and the ways by which the problems caused by poverty on people’s health can be overcome.

The financial status of an individual plays a huge role in his health status and sometimes prevents him from accessing essential healthcare services.

The poor often cannot afford certain essentials like healthy food and basic healthcare. They also do not have access to information on good health practices and their needs are ignored as their voices do not reach the concerned authorities.

A Vicious Cycle

• Just like how poverty can lead to ill health, the reverse is also true.
• Ill health can lead to poverty. When a person is sick, he ends up spending out of his pocket for consultation, diagnostic tests, etc.
• In case travel to avail specialty healthcare services is needed, the spending further increases as transportation costs, accommodation costs and food costs all add up.
• Ill health also means taking time off work which translates to a reduction in income.
• This is not only true for the breadwinner but also for the other family members who might be forced to give up their jobs to take care of the invalid.
• In extreme cases, to cover medical expenditure, people might be forced to sell their assets or borrow money at high interest rates.
• Thus, there is a vicious cycle that exists between poverty and poor health with each feeding the other.

The Unrecognized Effects of Poverty

Other than preventing access to healthcare, poverty has other effects too that are not as well-recognized.

• Poverty increases the possibility of mental health conditions, substance abuse and chronic conditions.
• Higher production of the stress hormone cortisol has been observed in individuals below the poverty line.
• Children who do not receive proper nutrition show impaired cognitive development which can affect their education, behaviour, etc.
• Studies have shown that suicide rates too are connected to poverty.

The Role of a Robust Healthcare System

Healthcare leaders need to promote a healthcare system that shines the spotlight on the needs of the poor.

• Family physicians can play a crucial role as they are acquainted with a patient and his/her family for a long time.
• They can help patients avoid or detect conditions at an early stage.
• On account of being acquainted with the patient for a long time, they are also aware of the patient’s financial status and can advise them suitably.
• Hospitals also need to have in place strong primary care teams to care for low-income patients as these patients typically have a higher incidence of chronic conditions and they also need help navigating health care systems.
• By showing empathy, physicians can forge a positive relationship with patients by promoting a non-judgmental atmosphere.

The Significance of Health Insurance

That ill health is concentrated among the poor is a known fact. Hence, there is a need to protect the poor from out-of-pocket expenses which can prove disastrous for them.

When people do not have basic needs like food, clothing and shelter, spending money for health insurance is the last thing on their minds. However, the fact that they too need health insurance cannot be ignored. Therefore, to make sure that the poor get the required medical services, a number of health insurance schemes have been introduced for people living below the poverty line (BPL) by the Government at the state and at the national level.

So, how do these health insurance plans differ from others?

• For starters, these schemes require a very low premium (sometimes as low as Rs.100 based on the plan opted for) and a renewal fee of Rs.30/-.
• The Government finances the entire premium or half of the premium.
• It offers both individual and floater coverage options.
• For pre-existing conditions, there is no waiting period under these schemes.
• Both public and private hospitals are covered under these schemes with cashless treatment available at network hospitals.
• Domiciliary treatment coverage (which refers to the treatment given at patients’ homes by doctors) is also available in most cases without any increase in premium.

Tamil Nadu of course has the Chief Minister’s Comprehensive Health Insurance Scheme that was launched in 2009. An amount of up to Rs. 5,00,000 per family is covered by this scheme on a floater basis. Those with an annual income of less than 1.2 lakhs per annum can apply for this scheme provided they have a family ration card. Along with the person applying for the insurance, the scheme also covers his/her spouse, children and a dependent parent.

The salient features of this scheme are listed below:

• Cashless hospitalization is offered by this scheme for the conditions/procedures covered by it.
• With a vast network of empanelled hospitals, the scheme strives to provide people (even those in distant regions) with quick access to medical care.
• It also covers a wide range of both in-patient and outpatient procedures.
• Unlike most other health insurance schemes, this also provides coverage for 8 follow-up procedures and 52 diagnostic procedures thus ensuring that people do not have to pay out of their pockets for these services.

Technology in Healthcare

• While the concept of telemedicine is nothing new, its widespread usage will significantly reduce healthcare costs. There will be no need for people to travel to avail a specialist consult. This takes away the cost of the travel, accommodation and other related costs.
• Doctors can remotely monitor patients and share medical records with their patients and other specialists thus making a comprehensive treatment plan possible.
• By having mobile applications that make available healthcare information and awareness articles in local languages, the public can be educated about health hazards, prevention measures, etc. and can also be told where to go to get the needed medical help.
• Community health workers play an important role in the healthcare sector as they are the link between healthcare services and the public. They can organize awareness drives, health camps and educate the public on healthy habits. Not only can digital health apps aid community health workers by keeping them updated on the latest healthcare developments, but they can also help them with the detection of medical conditions and referral of patients to the concerned departments. For this, training community health workers on using digital platforms is essential.

A Comprehensive View of the Issue

While the above-mentioned factors will all undoubtedly aid the poor in availing the required healthcare services, that alone does not solve the issue. To address the issue of healthcare for the poor, a multi-pronged approach which targets education, job generation, economic growth and other underlying causes of health inequities is needed.