THE HINDU Editorial Vocabulary- February 28, 2018 - Topic 2

No discrimination: on health insurance in India

The Delhi High Court’s order striking down a discriminatory exclusion clause in a health insurance policy, and upholding the claim of a patient, should have the broader effect of eliminating similar exclusions. The case involved a rare heart condition based on which United India Insurance Company rejected the claim, viewing it as a manifestation of a genetic disorder. By its very nature, such exclusion defeats the purpose of the health policy. 

But then, policies sold to individuals invariably contain a plethora of exclusions in the fine print, diminishing their practical value. They are heavily weighted in favour of the insurer. The court has struck a blow for the rights of the individual by holding that exclusion of the kind invoked does not just involve a contractual issue between the two sides, but the basic right to health flowing from Article 21 of the Constitution. It has gone further to interpret the right to health as being meaningful only with the right to health care, and by extension, health insurance required to access it. This is good advice. The Centre, which has committed itself to a universal National Health Protection Scheme, and the Insurance Regulatory and Development Authority would do well to heed it. They must review all the policies, and eliminate unreasonable exclusionary clauses designed to avoid claims.

Several studies have pointed out that health insurance in India suffers from lack of scale, covering only about 29% of the households surveyed under the National Family Health Survey-4, that too in a limited way. The health-care system also lacks regulation of costs. There is asymmetry of information, with the insured member unable to assess the real scope of the policy or negotiate the terms with the provider. Questions such as these led to the enactment of a new health-care law in the United States during the Barack Obama administration, whereby strict obligations were placed on insurers and unreasonable exclusions removed. India’s health insurance and hospital sectors closely follow the American pattern, and are in need of strong regulation. This is necessary to define costs, curb frauds and empower patients. As the Delhi High Court has observed, exclusions cannot be unreasonable or based on a broad parameter such as genetic disposition or heritage. Insurance law has to be revisited to also ensure that there is a guaranteed renewal of policies, that age is no bar for entry, and pre-existing conditions are uniformly covered. Problems of exclusion will be eliminated if the payer-insurer is the state, the financing is done through public taxes, and coverage is universal. Given its stated intent to ensure financial protection against high health costs, India should adopt such a course. The short-term priority is to remove discriminatory clauses in policies and expand coverage to as many people as possible.

Vocabulary

Discriminatory: making or showing an unfair or prejudicial distinction between different categories of people or things, especially on the grounds of race, age, or sex.

Example: Discriminatory employment practices

Synonyms: prejudicial, biased, prejudiced, preferential, unfair, unjust, invidious

Antonyms: indiscriminating, favourable, undiscriminating

Exclusion: the process or state of excluding or being excluded.

Example: Drug users are subject to exclusion from the military

Synonyms: censure, ejection, expulsion, exception, elision

Antonyms: inclusion

Manifestation: an event, action, or object that clearly shows or embodies something, especially a theory or an abstract idea.

Example: The first obvious manifestations of global warming

Synonyms: apocalypse, disclosure, revelation

Antonyms: cloud, cloudiness, concealment, hiding, mystery, obscuration

Diminish: make or become less.

Example: A tax whose purpose is to diminish spending

Synonyms: decrease, lessen, decline, reduce, subside, die down, abate

Antonyms: aggravate, amplify, continue, develop, enhance, enlarge

Heed: careful attention.

Example: If he heard, he paid no heed

Synonyms: attention, notice, note, regard, consideration, thought, care

Antonyms: carelessness, disregard, heedlessness, inattention, indifference

Negotiate: try to reach an agreement or compromise by discussion with others.

Example: His government's willingness to negotiate

Synonyms: discuss terms, talk, consult, parley, confer, debate, compromise

Intent: resolved or determined to do something.

Example: The administration was intent on achieving greater efficiency

Synonyms: bent on, set on, insistent on, hell-bent on, committed to

Antonyms: inattentive

Obligation: an act or course of action to which a person is morally or legally bound; a duty or commitment.

Example: He has enough cash to meet his present obligations

Synonyms: duty, commitment, responsibility, moral imperative, function

Antonyms: right

Assess: evaluate or estimate the nature, ability, or quality of.

Example: The committee must assess the relative importance of the issues

Synonyms: evaluate, judge, gauge, rate, estimate, appraise, consider, get the measure of

Regulation: a rule or directive made and maintained by an authority.

Example: Planning regulations

Synonyms: rule, ruling, order, directive, act, law, bylaw, statute, edict

Antonyms: nonstandard

Eliminate: completely remove or get rid of something

Example: A policy that would eliminate inflation

Synonyms: remove, get rid of, put an end to, do away with, end, stop

Antonyms: add, combine, complete, conjoin, fill up, increase

Interpret: explain the meaning of information, words, or actions

Example: The evidence is difficult to interpret

Synonyms: explain, elucidate, expound, explicate, clarify, illuminate