Plan your health expenses and insurance for eventualities

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Actor Shrivallabh Vyas’ demise is a lessonon why it is imperative to set aside a health budget every month

New Delhi, 09 January 2018: Actor Shrivallabh Vyas recently passed away, unable to pay his hospital bills. Late Vyas was known for his prominent roles in Aamir Khan’s Lagaan and Sarfarorsh, movies which performed well at the box office. However, unfortunately, this wasn’t enough for Vyas to consolidate his financial position. He was bed-ridden for few years after a paralytic attack in 2008. During the time he was in the ICU of a Jaipur hospital, his wife and daughters struggled to pay the medical bills. His medical expenses were taken care of by actors including Aamir Khan, Akshay Kumar, Manoj Bajpayee, and Irrfan Khan, among others.

In light of the above incident, it is time to revisit one’s health and plan health expenses. The Employee State Insurance Corporation (ESIC) premium is deducted on a person’s gross salary, which is 1.75% from the employee contribution and 4.75% from the employer contribution — a total of 6.5%.

Speaking about this, Padma Shri Awardee Dr K K Aggarwal, President Heart Care Foundation of India (HCFI) and Immediate Past National President Indian Medical Association (IMA), said, “Salaried people pay 6.5% from their salary for their health expenses. However, it is time to also consider those who are out of the ESI cover, especially the rich. Who is in charge of their insurance? It is imperative for every single person to plan health expenses. All of us should keep 6.5% of our monthly budget for health expenses including the insurance. The amount we spend on the insurance of our body should be double the amount that is spent on our car maintenance. Additionally, the government should ensure a centralized health savings scheme with a centralized fund management. This will ensure access to healthcare services for a larger segment of the society and help in realizing the goal of healthcare for all. This is also one of the issues that will be discussed at the 25th Perfect Health Mela to be held this year by the HCFI. This year marks the silver jubilee celebrations of the event.”

As per another survey, Indians are more likely to have a vehicle or life insurance than health insurance. Even those who have a health insurance, are below 2 lakh, which cannot cover a serious ailment such as a heart transplant.

Added, Dr Aggarwal, Group Editor, Indian Journal of Clinical Practice (IJCP), “As much as it is necessary to have a health cover, it is also important to have a health budget either monthly or build a corpus that will exclusively cater to your out-of-pocket expenses. The amount that one does not spend could be set aside to build a decent bank which can be utilized in the wake of a health emergency.”

Some planning tips are as follows.

  • Set a clear-cut savings goal every month. Use this only for the medical expenses.
  • Keeps these savings accessible and readily available for a crisis.
  • Just as a car needs maintenance, staying healthy requires maintenance too. Make sure you do not skip monthly check ups. This corpus can also aid in that.

Nuclear war (unlikely) threat

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Nuclear war (unlikely) threat. The United States and North Korea are threatening each other with nuclear strikes. The CDC is holding a session January 16 to discuss personal safety measures and the training of response teams at federal, state, and local levels. The unlikely event can happen and therefore there is need of general public to know about the first aid

o    Lie face down on the ground and protect exposed skin (i.e., place hands under the body), and remain flat until the heat and shock waves have passed. Cover your head.

o    Do not against looking at the blast, flash or fireball because you could go blind.

o    Cover the mouth and nose with a cloth to filter particulates from the inhaled air

o    If the explosion is some distance away, it could take 30 seconds or more for the blast wave to hit.

o    If a cloud of debris is moving toward them, leave the area by a route perpendicular to the path of the fallout.

o    If a cloud is not visible or the direction of the fallout is unknown, seek shelter. A basement or center of a high-rise building away from windows or doors would be best.

o    If possibly exposed to contaminated dust and debris, remove outer clothing as soon as is reasonable; if possible, shower, wash hair with soap and water, and change clothes before entering a shelter. Do not scrub harshly or scratch skin. Do not use conditioner in your hair because it will bind radioactive material to your hair.

o    People sheltering-in-place should go as far below ground as possible. Shut off ventilation systems and seal doors or windows until the fallout cloud has passed, generally a matter of hours.

o    Stay inside until authorities say it is safe to come out. Use stored food and drinking water.

Acute radiation syndrome may develop in those who are exposed to radiation levels of 50- 100 rad, depending on the type of radiation and the individual. Symptoms include nausea, vomiting, diarrhea, and reduced blood cell counts. Radiation, especially beta radiation, can also cause skin burns and localized injury. Fatalities begin to appear at exposures of 125 rad, and at doses between 300-400 rad, about half of those exposed will die without supportive treatment. At very high doses, greater than 1000 rad, people can die within hours or days due to effects on the central nervous system.

Radiation exposure inhibits stem-cell growth; for those who die within weeks to months, death is usually caused by damage to the gastrointestinal lining and to bone marrow where stem cell growth is crucial. Fetuses are more sensitive to radiation; effects may include growth retardation, malformations, or impaired brain function.

Treatment for acute radiation syndrome would include the prevention and treatment of infections, stem cell and platelet transfusions, psychological support, and careful observation of skin injury, weight loss, and fever.

  • Some standout features of the NMC Bill are as follows:

o    The government, under the National Medical Commission can dictate guidelines for fees up to 40% of seats in private medical colleges. Done to give students relief from the exorbitant fees charged by these colleges will actually increase corruption as in more than 60% of cases they may charge exorbitant fee

o    The Bill also has a provision for a common entrance exam and licentiate (exit) exam that medical graduates have to pass before practicing or pursuing PG courses. Done to ensure a higher standard of care will harm people who pass by grace. India is not ripe for this step in view of shortage of doctors.

o    Recognized medical institutions don’t need the regulator’s permission to add more seats or start a PG course. This mechanism will reduce the discretionary powers of the regulator. Earlier, medical colleges required the MCI’s approval for establishment, recognition, renewal of yearly permission or recognition of degrees, and even an increase in the number of students they admitted. Under the new Bill, the powers of the regulator are reduced to establishment and recognition.

o    Also a transparent and pro-active disclosure by the medical institution with regard to fees, facilities, faculty and infrastructure. A mandatory assessment and rating of medical colleges on annual basis to be carried out and published in order to enable prospective students to make an informed choice.

o    NMC Bill will pave the way for the back door entry of practitioners of traditional medicine into the domain of allopathic doctors via the Bridge Course. Instead of popularizing traditional medicines, this move encourages many traditional practitioners to gravitate towards allopathy.

o    Preamble of the NMC Bill states that “principle of the “regulated” electing the “regulator” is flawed and creates a conflict of interest, therefore MCI should be discarded”. By this argument the Bar council should not regulate advocates, ICAI should not regulate Chartered Accountants and so on and so forth. There must an equal proportion of elected representatives.

o    The NMC will split the selection, advising, and actual accreditation process into three separate boards. By dividing power, the hope is to create a system of checks and balances. However, as per the current Bill, all members of the accreditation board are supposed to be ex-officio members of the advisory board. This defies the logic of good governance.  [Ushy Mohan Das: The Indian Express]

  • Max case: DMC decision crucial. The Delhi Police will proceed with its probe into the case of a newborn being erroneously declared dead by Max Hospital, Shalimar Bagh, only after it receives a reply from the Delhi Medical Council (DMC) on whether there was medical negligence in the matter. DMC has received replies from the doctors and nurses, and that these will be put up before its executive committee. The committee will form an expert panel.
  • 1.56 crore abortions in India in 2015. “A report published in Lancet Global Health Medical Journal mentions that about 1.56 crore abortions took place across India in 2015. The study is based on a sample of six states and is not representative of the country,” said Union Minister of State for Health and Family Welfare Ashwani Kumar Choubey in a written reply in the Lok Sabha.
  • Government rejects WHO report. The government termed as “erroneous” a World Health Organisation report which claimed that 57 percent of allopathic doctors in India do not have medical qualification. “The report is erroneous since MBBS is the minimum qualification for enrolment as registered medical practitioner in a state medical register to practice medicine, and hence all registered doctors have medical qualifications,” Union Minister JP Nadda told the Lok Sabha in a written reply to a question. Central government has requested the chief ministers of all states to take appropriate action against quacks and evolve suitable policies to ensure availability of quality health workforce in rural areas.
  • Tobacco should have 85% pictorial warnings. Ten medical associations and 453 doctors from across the country, including those from Tata Memorial Hospital in Mumbai and AIIMS, in Delhi, have written to Prime Minister Narendra Modi, protesting against a recent Karnataka High Court order reversing 85 per cent pictorial warnings on tobacco packets, in force since April 2016.
  • HCFI calls for cancer drugs to be under price control to make it affordable for masses. Although cancer has become like an epidemic with a steep rise in its incidence, the cancer medicines are very expensive and beyond the reach of common man. Therefore, government should bring price control on all cancer drugs to make them affordable to people, said Dr K K Aggarwal, president of Heart Care Foundation of India (HCFI). The government should also take adequate steps to ensure early diagnosis of cancer because it is a proven fact that early diagnosis can save many lives, said Dr Aggarwal who is also immediate past national president, Indian Medical Association (IMA). “Cancer treatment can get more expensive if it is diagnosed late, or if the diagnosis and treatment are not right,” he said.

There are scores of people grappling with the exorbitant costs of cancer care in India, where the disease has taken away entire life savings and even forced some people to sell their assets. Though the cancer treatment in India is cheaper than West, it is still unaffordable for poor and middle class who do not have health insurance. The minimum cost of six months of treatment ranges from Rs.2.5 lakh with low priced generic drugs to Rs.20 lakh with novel drugs and targeted medicines. For instance some breast cancer patients need targeted treatment drugs, such as Herceptin produced by MNC Roche costing around Rs.75,000 for a course; a patient could need up to 17 courses. Similarly, Avastin which treats colon, kidney, lung and gall bladder cancers costs Rs.1 lakh a cycle. Though companies have patient support programmes, most patients end up paying 70 to 80 per cent of the medicine prices … (Pharmabiz, Laxmi Yadav).

Dr KK Aggarwal

Padma Shri Awardee Vice President CMAAO Group Editor-in-chief IJCP Publications

President Heart Care Foundation of India

Immediate Past National President IMA