When the Union finance ministry announced a special insurance scheme for healthcare workers battling the novel coronavirus epidemic, it was welcomed by public health experts. “Any health professional, who while treating Covid-19 patients, meets with some accident, then he/she would be compensated with an amount of Rs 50 lakh,” said the government press statement on March 26.

But four days later, it became clear that the scheme would only cover the death of healthcare workers, not their treatment.

On March 30, a policy document released by the New India Assurance, the company tasked with implementing the scheme, defined coverage as “death due to complications arising out of accidentally contracting Covid-19 pandemic disease” while treating and attending to patients.

This means the families of health workers would be compensated in the event of their death – but the workers themselves would not get any financial help in case they fell ill and needed to be hospitalised. With a large section of India’s health workforce, particularly those in the lower rungs, not covered by existing insurance schemes, public health activists say this could be a recipe for disaster.

Health workers have complained of crippling shortages of protective equipment across India. Till April 2, at least 52 health workers, including doctors, nurses and cleaners, had contracted the infection while at work.

“If nurses get Covid-19 and require hospitalisation in a private hospital, it will devastate them economically,” said Jibin TC, the president of the United Nurses Association in Maharashtra. Most mid-level nurses in private hospitals earned between Rs 11,000-13,000 and did not have institutional health cover, he said. “The government should ensure all treatment anywhere is free,” he said.

Scroll.in emailed the Ministry of Finance and the Ministry of Health and Family Welfare asking whether the government had plans to cover the treatment and hospitalisation expenses of healthcare workers in addition to the accidental death insurance. The emails went unanswered.

This article will be updated if and when the ministries respond.

The policy document released by New India Assurance Co Ltd.

High costs of private care

The government’s special Covid-19 insurance package will cover 22.12 lakh public health workers, including community health workers called Accredited Social Health Activists or ASHA. It will also cover private health workers, said a press release from the Union Ministry of Health and Family Welfare on March 29.

The insurance coverage will be in place for 90 days starting March 30.

While public hospitals are providing free Covid-19 treatment, experts say as the number of cases rise, these hospitals could get overwhelmed. Many patients, including healthcare workers, may have to fall back on private hospitals.

Intensive care unit admissions cost anywhere between Rs 40,000 and Rs 1.25 lakh per day in private hospitals, said Dr AV Srinivasan, former president of the Indian Academy of Neurology. Some Covid-19 patients may require ventilator support, which would further add to the costs, he said.

“Assuming some of the healthcare workers have health insurance of Rs 2 lakh on their own, it will be exhausted in a matter of days if they become seriously ill,” Srinivasan said.

A covid patient who was ventilated in a mumbai pvt hospital has recovered & been discharged. Great news. Good for him & his family. PS : the bill Rs 12 lakhs paid by his employer. — sanjay nagral (@sanjaynagral) April 1, 2020

Ayushman Bharat is not the solution

The government has announced that Covid-19 care would be included under the national health protection scheme, which is part of the Ayushman Bharat programme. However, many categories of healthcare workers will not be covered under the scheme given its narrow eligibility criteria, said Indranil Mukopadhyay, associate professor of public health at the OP Jindal University and member of the Jan Swasthya Abhiyan.

Under the Ayushman Bharat, the eligibility is decided on whether a person in a rural area fulfills the deprivation criteria as identified by the Socio-Economic and Caste Census. This includes factors such as a family living in a one-room house with kuchha walls and roof, Scheduled Caste and Scheduled Tribe households, families having no adult member between the ages of 16 years and 59 years, and so on. In the urban spaces, the scheme covers only 11 occupational groups, which does not include healthcare workers.

Other government health insurance schemes are also narrowly defined, said Mukopadhyay. For instance, the Employment State Insurance Scheme provided by the Union Ministry of Labour covers 3.47 crore workers who are employed in firms with more than 10 workers and earn less than Rs 21,000 per month. It is not clear how many of these workers are in the health sector.

There is no data on how many healthcare workers have health insurance, said Mukhopadhyay, but coverage is poor across all sections of the Indian population.

“Death due to Covid-19 is rare,” Mukopadhyay added. “So the [newly announced] scheme would not fulfill its goal of protecting healthcare workers if it does not cover hospital and treatment charges.”

Even the scheme’s coverage of 22.12 lakh public health workers could be an underestimation, he said. Many hospital workers, like the sanitation staff, are contracted through third-party agencies. In their contracts, they may not even be classified as healthcare workers. “The government should also include categories like these so that no one is left out,” he said.

The fears of health workers

The government has roped in community health workers called ASHAs in community-level screening and tracing activities for Covid-19 detection. Placed on the frontline, in many states, ASHAs have not even been given masks for protection.

Many ASHAs do not have insurance cover under Ayushman Bharat and the Employment State Insurance Scheme, said D Nagalakshmi, Karnataka State Secretary of ASHA Workers Union.

In Karnataka, they earn Rs 10,000 a month – income levels that make them ineligible for Ayushman Bharat insurance, but are inadequate for private hospitalisation expenses. They have access to accidental death and disability cover under the Pradhan Mantri Suraksha Bima Yojana and life insurance under Pradhan Mantri Jeevan Jyoti Bima Yojana. “But we do not know if any of these schemes would cover Covid-19 treatment,” Nagalakshmi said.

Chamundeshwari, 29-year-old ASHA from Mysuru district, said officials had told them that they will get free government treatment in case they fell ill. But she pointed out many of her colleagues lived far away from the designated Covid-19 public hospital. If they had to access private hospitals, they might not be able to afford them.

She said their existence was precarious because payments were often delayed. “While we are promised Rs 10,000, we were only getting Rs 6,000. Two months ago, we had to protest to force the government to release the rest of the money.”

“My husband runs a small plumbing workshop, which has been closed for two weeks now. There has been no work,” she added.

“If we go on surveys and get corona [virus], I am really worried,” she said. “The government should do something.”