Keeping the Health Fund healthy

The Auroville Health Fund ran into its first ever deficit in the financial year 2013-2014 with expenses exceeding the income by more than Rs 12 lakhs. It is a worrying development. Private hospitals in Pondicherry have increased their prices exponentially, while the Fund’s income hasn’t kept up. The only reason why the deficit hasn’t been charged to the Health Fund members is that there were sufficient reserves. But they won’t last.

The Auroville Health Fund was set up in 2002 as an internal cooperative fund. All income is used to cover the health costs of the members. A positive balance increases the Fund’s reserves, but a deficit has to be covered by all the members. Until 2012-2013, the balance had been positive. But in recent years, the reserves hardly increased.

A Health Fund Advisory Group setup by the Budget Coordination Committee (BCC) is looking into ways to keep the Fund healthy and to advise on the extent of its coverage. There is a strong pressure to cover more treatments of alternative health care providers – the Fund already covers homeopathy, shiatsu, acupuncture, treatments by the Tibetan doctor and ayurvedic treatments – as well as the costs of preventive medical care, but as the Fund is already in minus, the Group is unlikely to recommend such extensions soon.

One way to meet the deficit is to substantially increase the monthly contribution of the members, a move which the BCC is hesitant to take. The BCC pays all maintenances for Aurovilians working for Auroville Services and covers their Health Fund contribution. The BCC’s income is already stressed by its recent decision to increase the maintenance, and it would be hard put to increase the Health Fund contribution as well.

Another way would be to limit the coverage which the Health Fund provides. But, clearly, this is not an option as too many Aurovilians have no assets or additional sources of income and would not be able to meet any not-covered expenses. Moreover, it would go against one of the basic tenets of Auroville, as mentioned in A Dream, that the community “would provide for each individual’s subsistence and sphere of action.”

A better way is reducing expenditure, for example by ‘empanelling’ private hospitals (making specific price agreements), which is how many health insurance companies keep the costs down. Lastly, it has been suggested to only cover treatments done at JIPMER, the Jawaharlal Institute of Postgraduate Medical Education and Research, a government hospital in Pondicherry that ranks among the top five medical institutes in the country and which provides, within certain limits, healthcare free of cost. But admission is notoriously difficult, as JIPMER treats hundreds of patients a day. There was a case of an Aurovilian who went to JIPMER for an emergency, but left after waiting for hours as he was not being attended to. Also, in some cases, better specialists can be found in other hospitals.

A combination of all the proposals is being worked out. Some increase of the monthly contribution will be inevitable, as is the need to reduce costs by empanelling hospitals and increasingly referring patients to JIPMER.