Pulse

Traditional medicine covers need a shot of dynamism

PT Jyothi Datta | Updated on May 25, 2018

For starters, the government could provide insurers a compendium of approved services

The countdown has begun for International Yoga Day coming up later next month — a high-profile event that will see Government representatives exhibiting their Yoga skills to encourage others to adopt and benefit from these traditional techniques that promote good health.

If there’s a thread to pick up here, it is how a nudge from Government helps fan an idea across the country.

And yet, the enthusiasm for Yoga is not reflected with as much fervour when it comes to health insurance coverage for Ayush (Ayurveda, Yoga and Naturopathy , Unani, Siddha and Homeopathy) — the traditional systems of medicine.

Health insurance products in the marketplace, presently, address in-patient and, in limited cases, out-patient Ayush services. But they continue to grapple with challenges of standardisation of traditional systems of medicine, limited organised infrastructure to treat those seeking this line of healthcare and the classic dilemma of supporting preventive treatment before it escalates into a situation requiring hospitalisation and surgical intervention.

The error is in viewing traditional medicine through the same lens as modern or allopathic medicine, say experts, calling for an outside-the-box approach to design products for alternative systems of medicine. And the blame for the absence of dynamism in addressing the very core issue of traditional medicine systems is laid equally at the doorstep of the government and the insurance industry.

“It is a chicken-and-egg situation”, says Shailaja Chandra, former Ayush secretary with the Central government.

The systems are different, depending on which school of practice is followed; whether practised in the North or South of the country; the credentials and experience of Vaidyas, and whether treatment includes out-patient care only, hospitalisation or both, she says.

“So rather than wait for Utopia to descend, it will be better for the Government to publish a compendium of approved/certified services, a medical directory of peer-reviewed facilities and services,” she says, so health insurance companies have a more organised framework to deal with.

Alternative systems score

Alternative systems of medicine play an important role as non-communicable diseases (NCD) like hypertension, diabetes and cancer increase in the country, she says.

Chandra’s earlier research found that people moved away from allopathy to reduce the dosage of current allopathic medication, avoid surgery and side effects of treatment. “Ayush is best as adjuvant therapy (intervention after initial treatment to enhance the body’s immunity), say, to improve the quality of life of a terminally ill patient,” says Chandra. She cites the example of an oncologist with a corporate hospital who publicly stated that Ayurveda helped in improving the appetite and metabolism in a cancer patient undergoing chemotherapy.

Towards a compendium

A compendium will “work like a Bible” for stakeholders in listing out registered medical facilities and doctors, on a state and district basis, says Chandra.

It can be compiled under the Government’s direction by an outsourced team comprising doctors from both sides, insurance company representatives and patient groups. “Once benchmarks are set, an agency like NABH can register applicants and treatment services offered,” she suggests. Hospitals can also do comparative therapeutic studies over a limited time frame to map treatments and outcomes and help draw up protocols and guidelines, she says, as a start, however small, needs to be made. A review of health insurance packages provided by public and private companies revealed that individual products with a wide range in coverage were more the exception. Most individual products have only a fraction of their total sum insured going towards reimbursing Ayush services.

Standardisation

Bhaskar Nerurkar, heading the health administration team with Bajaj Allianz General Insurance Co, says their group products cover out-patient services too.

But a greater standardisation of traditional treatment procedures is required, he says, as insurance kicks in only when there is hospitalisation and treatment. Industry hands admit that insurance products need greater refining, but restraining them is the fear of frauds and increased claims for non-specific treatments. Regulatory expert Dr DB Anantha Narayana says that dynamic products for traditional medicine systems are imminent as consumers lean towards alternative practices. Consumers will force the change, else companies will face the heat, he points out.

Published on May 25, 2018

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