Monday, 22 April 2013

HOW I THINK MODERN HEALTH CARE SHOULD TOUCH THE LIVES:-UNIVERSAL FREE HEALTH CARE SYSTEM.

This blog has specifically written in response to the Apollo Hospitals initiative to bring innovations in key medical specialties be it in preventive health check ups,robotic surgeries or transplants on par with the West. Apollo Hospitals invited  Indibloggers to tell them of providing the  sheer joy of stress free life without worrying of health.
It is indeed a commendable initiative and Apollo Hospitals must be complimented and commended for taking such a BOLD initiative.
 But my definition of providing sheer joy of stress free life in preventive health care be it any sphere should be in addition without worrying of health MUST ALSO BE INCLUDED AS NOT WORRYING OF MONEY.
Dr.Deviprasad Shetty of Narayana Hridayalaya at Bangalore has already declared and committed  that no patient will go back from his hospital without medical help because of money. This itself is commendable initiative that needs to be supported by anyone who is interested in providing health care.

The Yasasvini health care which is another initiative of Dr.Devi Prasad Shetty by which all those Credit Co-operative societies and Co-Operative Banks will be covered by the respective Cooperatives itself by joining the group insurance by paying  nominal premium charges  on behalf of all their shareholders.so that they are covered for all the expenses for the surgery. However, this is applicable only for limited number of people who are members of the society and the society opts for the scheme.

The aim should be and must be to provide UNIVERSAL FREE HEALTH CARE FOR ALL. We need not ape any plans that exists in other parts of the world either in the West,East,North or South. India can be a model state for others to emulate so as to make our country is the one and only country of providing UNIVERSAL FREE HEALTH CARE FOR ALL.
As of now there are various schemes in place which is providing health care at free of cost for limited number of people. If improvement and tweaking of the following schemes are undertaken by expanding the beneficiaries and the limits it will go a long way of achieving of providing UNIVERSAL FREE HEALTH CARE FOR ALL.
1.YASASWINI:-
For the members of Credit Co-operative in Karnataka who opt for the scheme and pay the premium on behalf of all its members and covers free heart surgery in Association with Narayana Hridayalaya of Dr.Devi Prasad Shetty. The members will get free treatment without any limit and he or she need not spend anything.
Expansion to be initiated: State Governments can provide Smart Cards for All its Citizens and pay the premium charging only nominal fee of Rs.100 per year.

2.RASHTRIYA SWASTHYA BIMA YOJANA.( For BPL Families only)
This is a scheme which was implemented by Union Ministry of Labour & Employment with effect from 1st April.2008.
The beneficiary has to pay only Rs.30 as a registration fee to obtain the smart card.
As on 15 April 2013 the active Smart Card issued to 34,465,253.
The total Hospitalisation cases  5,211,780.
Expansion to be initiated:The Union Labour Ministry can remove the tag of BPL and expand it to all the unorganised sector and issue SMART HEALTH CARE CARDS by collecting a nominal charge of Rs.100 per year and provide free health care to all.All the private and public sector hospitals must provide cash free treatment to all.The premiums has to be paid by the Union Government. Primary Health Centre(PHC) must be opened in all villages in collaboration with private hospitals  to provide free health care. One PHC for every 1000 people.

3.LIC's AAM AADMI BIMA YOJANA.( A SOCIAL SECURITY SCHEME)

AAM ADMI BIMA YOJANA, a prestigious scheme of the Central and State / Union Territory Governments and administered by LIC brings a ray of hope and smile to these households. 


I In the event of death of a member prior to the terminal date, the Sum Assured of Rs.30,000/- will become payable to the nominee.
Accident Benefit: In the event of death by accident or Total / Partial Permanent Disability due to accident, the following benefits shall become payable:

a) on death due to accident                                 Rs.75,000/-
b) Permanent total disability due to accident          Rs.75,000/-
c) Loss of one eye or one limb in an accident         Rs.37,500/- 
A free add-on scholarship benefit for the children of the members of AABY is provided under the scheme. A scholarship at the rate of Rs. 100/- per month will be given to maximum two children studying between 9th to I2th Standard. This scholarship, however, is payable half yearly - on 1st July and on Ist January, each year.

PREMIUM
  • The premium under the scheme shall be Rs.200/- out of which 50% shall be subsidized from the Fund created for this purpose by the Central Government and the remaining 50% shall be contributed by the State Government.
  • The premium shall be payable in yearly mode and no relaxation of mode of payment will be allowed.
  • Experience rating adjustment will be allowed after 3 years based on claim experience, if the group is of 2,000 or more members. Even if the group size is small and the claim experience is adverse, LIC may review the rates.
Expansion to be initiated: The cap on limit must be removed and free health cover must be provided with suitable increase in case of death of the head of the family.

4.Employees State Insurance Corporation of India.(ESIC): TOUCHING LIVES AS NONE OTHER


The section 46 of the ESI Act  1948 envisages following six social security benefits :- 

(a) Medical Benefit : Full medical care is provided to an Insured person and his family members from the day he enters insurable employment. There is no ceiling on expenditure on the treatment of an Insured Person or his family member. Medical care is also provided to retired and permanently disabled insured persons and their spouses on payment of a token annual premium of Rs.120/- .
  1. System of Treatment
  2. Scale of Medical Benefit
  3. Benefits to Retired IPs
  4. Administration of Medical Benefit in a State
  5. Domiciliary treatment
  6. Specialist consultation
  7. In-Patient treatment
  8. Imaging Services
  9. Artificial Limbs & Aids
  10. Special Provisions
  11. Reimbursement
(b) Sickness Benefit(SB) : Sickness Benefit in the form of cash compensation at the rate of 70 per cent of wages is payable to insured workers during the periods of certified sickness for a maximum of 91 days in a year. In order to qualify for sickness benefit the insured worker is required to contribute for 78 days in a contribution period of 6 months.
  1. Extended Sickness Benefit(ESB) : SB extendable upto two years in the case of 34 malignant and long-term diseases at an enhanced rate of 80 per cent of wages.
  2. Enhanced Sickness Benefit : Enhanced Sickness Benefit equal to full wage is payable to insured persons undergoing sterilization for 7 days/14 days for male and female workers respectively.
(c) Maternity Benefit (MB) : Maternity Benefit for confinement/pregnancy is payable for three months, which is extendable by further one month on medical advice at the rate of full wage subject to contribution for 70 days in the preceding year. 

(d) Disablement Benefit
  1. Temporary disablement benefit (TDB) : From day one of entering insurable employment & irrespective of having paid any contribution in case of employment injury. Temporary Disablement Benefit at the rate of 90% of wage is payable so long as disability continues.
  2. Permanent disablement benefit (PDB) : The benefit is paid at the rate of 90% of wage in the form of monthly payment depending upon the extent of loss of earning capacity as certified by a Medical Board
(e) Dependants' Benefit(DB) : DB paid at the rate of 90% of wage in the form of monthly payment to the dependants of a deceased Insured person in cases where death occurs due to employment injury or occupational hazards. 

(f) Other Benefits : 
Funeral Expenses : An amount of Rs.10,000/- is payable to the dependents or to the person who performs last rites from day one of entering insurable employment. 
Confinement Expenses : An Insured Women or an I.P.in respect of his wife in case confinement occurs at a place where necessary medical facilities under ESI Scheme are not available. 

In addition, the scheme also provides some other need based benefits to insured workers. 

Vocational Rehabilitation :To permanently disabled Insured Person for undergoing VR Training at VRS.
Physical Rehabilitation : In case of physical disablement due to employment injury. 
Old Age Medical Care :For Insured Person retiring on attaining the age of superannuation or under VRS/ERS and person having to leave service due to permanent disability insured person & spouse on payment of Rs. 120/- per annum.
Rajiv Gandhi Shramik Kalyan Yojana : This scheme of Unemployment allowance was introduced w.e.f. 01-04-2005. An Insured Person who become unemployed after being insured three or more years, due to closure of factory/establishment, retrenchment or permanent invalidity are entitled to :-
  • Unemployment Allowance equal to 50% of wage for a maximum period of upto one year.
  • Medical care for self and family from ESI Hospitals/Dispensaries during the period IP receives unemployment allowance.
  • Vocational Training provided for upgrading skills - Expenditure on fee/travelling allowance borne by ESIC.
Incentive to employers in the Private Sector for providing regular employment to the persons with disability :
  • Minimum wage limit for Physically Disabled Persons for availing ESIC Benefits is 25,000/-.
  • Employerss' contribution is paid by the Central Government for 3 years.
Benefits & Contributory Conditions :
An interesting feature of the ESI Scheme is that the contributions are related to the paying capacity as a fixed percentage of the workers wages, whereas, they are provided social security benefits according to individual needs without distinction.
Cash Benefits are disbursed by the Corporation through its Branch Offices (BOs) / Pay Offices (POs), subject to certain contributory conditions. 



There may be many more such schemes which I am aware of.
In addition to this almost all private sector and public sector undertakings enter into group health insurance policies  in the name of their  employees and their family members.Almost all public sector and government employees & their family members are covered even after their retirement also as a social security measure.
Some of the private sector companies also cover their retired members and their family for health cover.
This will leave out only a section of the citizens without any cover.

Now as per the new companies bill CSR( Corporate Social Responsibility),certain percentage of their profits has to be mandatory to be spent on social activities.

5-PRIVATE HOSPITALS MUST PROVIDE FREE SERVICE TO 50% OF ITS PATIENTS
In many states it is mandatory for the private hospitals who are given land by the government and tax concessions for their research work and importing of  machinery & equipment.  But these benefits are not passed on to the really deserving patients. If all the private hospitals serve the people with the single motive of service to the people and care about the health of the citizens it must work with the service motive rather than on profit motive.
Some of the private hospitals have become Business Enterprises and almost forgotten their motive to serve and take care of the patients. They now take care of their promoters and shareholders at the cost of the patients. Exorbitant charges are made and luxurious five star facilities are provided which could have been spend on reducing the cast in providing necessary health care to the patients.

I have provided the nitty gritties of the various schemes to provide the total amount of money that is being spent under various schemes and if all these all brought under one umbrella and make the PRIVATE PUBLIC PARTNERSHIP(PPP) by providing Universal Free Medical  Care a reality in the following manner

1.All public sector employees & their families to be covered for life and health insurance by paying the premium during and and after retirement by collecting small amount of Rs.100 as registration.
2.All private sector employees & their families to be covered for life and health insurance  in similar way as stated above.
3.All those not employed either in  government, public sector or private sector.premiums must be paid by the government by collecting Rs.100 as registration fee for providing Smart card for free health care.
4.ESI Hospitals,Railway Hospitals,Army hospitals,Government Hospitals & Private hospitals will get their reimbursement from the life and general insurance companies so that  A CASH LESS FREE HEALTH CARE IS PROVIDED TO ALL.
5.Government, public sector & private sector must fund the hospitals to get latest technology equipments to hospitals from their CSR budget.
6.Charitable institutions who contribute to these hospitals only must be allowed tax concessions and all other income of charitable institutions must be made taxable.
For few it may look UTOPIAN, but Apollo Hospitals can make a beginning by providing 50% of its patients free medical service and declare that the corporate objective of the Apollo Hospital is to provide FREE HEALTH CARE FOR ALL & PROFIT OF THE HOSPITAL IS TO BE SHARED WITH THE PATIENTS TO PROVIDE FREE SERVICE AND NOT TO SHARE WITH PROMOTERS & SHAREHOLDERS
http://www.apollohospitals.com/cutting-edge.php