OPINION

Reverse Mortgage in Health Care

June 09, 2007
Shantanu Dutta

India's premier medical institute, the All-India Institute of Medical Sciences, is still grappling with an acute shortage of corneas. Dr. Rajendra Prasad Centre for Ophthalmic Sciences at AIIMS currently has a waiting list of 250 to 300 top priority patients this month who are blind in both eyes and are young. Similarly, over three million people in India suffer from end-stage renal disease, yet only 2,500 people receive kidney transplants every year. Experts who held a brainstorming session on Saturday to find ways to bridge this yawning gap, found a two-pronged solution: a dose of awareness in the community and suitable amendments to the law governing human organ transplants.

The severe shortages which happen due to several reasons including religious beliefs and superstitions lead to at least three things. Firstly it means that many people who need organ transplants, be it corneas or kidneys or any other suffer the consequences, be it perpetual blindness or a chronic death. Secondly, for those who receive transplants, the costs are prohibitive. Thirdly, because of shortages, rackets thrive in organs, especially kidneys for which India, among others is notorious.

Healthcare in India and globally is daily growing more expensive and it has always been a challenge to deal with these rising costs. Insurance has not penetrated large sections of the population and will not in the foreseeable further even if the industry expands and then not every one is insurable anyway. Those who do not have insurance and fall sick, lack of access to quality public health services and a rapidly growing unregulated private sector have led to a situation where an increasing number of people are getting trapped in debts or slipping into deeper poverty due to the expenses of hospitals. At the national level, at least 25 per cent of hospitalized people are falling below the poverty line only as a result of hospital-related expenses.

Considering that insurance is not going to be the complete answer and that meeting hospital expenses from out of pocket are increasingly pushing people into debt, it is time to do things differently. Considering that so much of healthcare is getting commercialized anyway, it is time to adopt a practice that has just been introduced in India in a small way - the concept of reverse mortgage. Can reverse mortgage, which has thus far been introduced to provide a safe haven of housing for senior citizens be adapted to health. Yes.

Reverse mortgage contracts in health can work for healthcare institutions, possibly corporate ones in the first place as they are usually the early adaptors. Such institutions can provide free or subsidized healthcare for individuals, who stipulate that on their death, they would donate their organs for transplant to those who would need it. This could be particularly tried out among senior citizens who are usually not insurable and to ensure that hospitals and clinics are not tied up by contracting to provide treatment to the young for decades. Of course adequate ethical and systems checks and guidelines need to be in place to ensure that clinical care is not compromised in the race to harvest organs for transplantation but with adequate regulation in place, reverse mortgage can provide a viable health care financing option for those who are not insurable and who would typically find the costs of treatment to be high. Such a route would provide healthcare for senior citizens; a regular supply of organs for transplant and somewhat ease the organ racket. An idea worth exploring and whose time has come!

Shantanu Dutta is a medical doctor by training and a development professional by vocation. His writings mostly deal with change, complexity and conversion and tries to look at a changing world through heaven's eyes.
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