Keeping Auroville healthy in body and pocket

Auroville’s Health Fund Scheme (AHFS) was established in 2002, in recognition of the fact that many Aurovilians struggle to meet the high costs of healthcare for unexpected or serious illness and complex conditions. In the spirit of Auroville’s ideals, the scheme is an internal cooperative health system, where the community carries the medical costs of all members of the scheme. In contrast to most external health insurance funds, it does not aim to make a profit. It offers coverage for a much wider range of treatments than conventional funds, all for a reasonable monthly contribution.

Surprisingly, the Health Fund has never gone into deficit, even though the costs of healthcare are rising and Aurovilians are increasingly undertaking treatment in private medical institutions in Pondicherry. Even though the fund’s balance has been very low at times, it has “magically recovered” every time, according to the Fund’s administration.

The Fund receives approximately 11 lakhs each month in member contributions and all this income is used to cover members’ healthcare costs. It receives no extra funding, such as donations or a regular budget from Auroville. Participation is mandatory for Newcomers, and strongly recommended for Aurovilians. The majority of Aurovilians and Newcomers are enrolled in the scheme – at last count, it had 2099 adult members and 513 children. Members’ monthly contributions were recently increased to Rs 500 per month for adults (Rs 250 for children), after being fixed at Rs 450 for six years.

As well as covering standard items such as visits to Auroville’s doctors, the Fund offers reimbursements for a wide range of items, including prescribed medicines, blood, urine and stool tests, glasses, hearing aids and orthotic care (shoe modification by an Auroville orthotist), and certain alternative therapies offered in Auroville, such as homeopathy, acupuncture, Ayurveda and Tibetan medicine. The coverage for hospital expenses is wide, and includes specialists’ fees, medicines, scans and x-rays, dialysis, chemotherapy, radiotherapy, pace-makers and lenses.

Inevitably, there are challenges to managing a health fund with an ageing population, especially with rising healthcare aspirations and the proliferation of costly, high-end treatments in the last decade.

Given that many of Auroville’s pioneers are now in their 70s and 80s, there is an increasing number of age-related medical expenses being claimed, especially for surgeries like cataract removal and hip or knee replacement. And while Newcomers over the age of 55 years old are required to have their own private insurance in addition to membership in the Health Fund (because older people are perceived as posing a higher financial risk to other members), many Newcomers drop their private health insurance when they become Aurovilian, which means their expenses might fall back on Auroville more generally as they age.

The Fund’s administration also explains that there is sometimes a conception that the Fund is like a health insurance scheme, in which people have a choice of private hospital. However, the Fund aims to provide equal support to all members, which financially means there are some limitations around choosing a hospital. The scheme has ‘empanelled’ approximately 18 Pondicherry hospitals into the Fund (which involves making specific price agreements) which means that Aurovilians are refunded for most costs of hospitalisation in those institutions, based on a certain room category which defines the overall cost. But if Aurovilians want to have surgery at a private hospital in Chennai, they have to pay the extra costs that exceed the Fund’s cap on costs.

The Fund often recommends JIPMER hospital to its members –  a Central Government teaching hospital in Pondicherry. This recommendation is made not to save the Fund money (most treatment in JIPMER is free), but because of JIPMER’S reputation for a high level of medical expertise. In fact, patients from all over south India travel to JIPMER for treatment. However, many Aurovilians find the crowds and long waiting times to be onerous there, and therefore opt for a private institution with shorter waiting times and more personalised care. The Fund’s administration suggests that Auroville could follow the Ashram’s example and create a liaison person with JIPMER, which could make admission easier and faster for Aurovilians. They emphasise that medical expertise at private hospitals is not necessarily better, and Aurovilians sometimes end up dissatisfied with the health outcome while having to pay a very high bill – only part of which is paid for by the Health Fund.

Another difficulty the Fund staff cites is that health conditions stemming from unhealthy lifestyles, including alcohol abuse or smoking, place a burden on collective funds.

Home care expenses (such as a home nurse or attendant) are not covered by the Fund as they are generally very expensive, and the costs of long-term care in a nursing home facility are considered on a case-by-case basis. Auroville has attempted to address this issue through the creation of Marika Home and Mahalakshmi Home, where elderly Aurovilians can reside and receive a high level of care.

While there have been suggestions to place a ‘cap’ on the total reimbursement given to one person (for example, if a member has a series of costly hospital surgeries or ongoing treatment for complex conditions), there is currently no limitation on the maximum refund a person can receive. This policy is currently being reviewed, as the Fund is becoming depleted by the recurring expenses of a small number of members. 

The Fund’s administrators emphasise that one of the most difficult parts of their job is that of being in a small community, where they are known to many, and seemingly approachable. Some members approach them in public spaces with an expectation that a claimed refund will be granted, or phone them at random hours to express disagreement about reimbursements. This is in contrast to the lack of personal contact that characterises external insurance funds.

When complicated reimbursement cases arise, a support group appointed by the Budget Coordination Committee (BCC) gives its input and makes the final decision. When Fund members disagree with the outcome, they can appeal to the BCC.

The pandemic has also posed challenges, and has led to an increase of general hospital costs. For example, PPE kits worn by doctors and nurses for any kind of procedure are now added to hospital bills, often increasing the bill by Rs 5000 –  Rs 10,000 (depending on the duration of the stay at the hospital), as are COVID tests for anyone admitted to hospital for any kind of treatment.

Despite these challenges and increasing costs, Auroville’s Health Fund Scheme is a fair initiative when one compares the monthly contributions and lack of cost caps against the average cost of general health insurance in India, which can cost two or three times the price and has strict caps on costs. The scheme can be seen as an example of how Auroville can intersect with rapidly commercializing external sectors through supporting community members to access such services while acting in the interests of Auroville’s values and cooperative spirit.