Project esis hospital

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Project esis hospital

  1. 1. ESIS Hospital 1
  2. 2. Acknowledgement..............................................................4Objectives Of The Study:.....................................................5Employee State Insurance Corporation....................................6ESI Scheme.......................................................................8 Corporation.................................................................................8 Constitution of Corporation.............................................................9 Statement...................................................................................9Coverage Under The ESI Act, 1948 .......................................10 Areas Covered............................................................................10 States ...............................................................................................10 Union Territories ........................................................................10 Coverage :.................................................................................10 Finance.....................................................................................11 Income / Expenditure Account...............................................................11 Contribution...............................................................................12 Collection of Contribution....................................................................12 Contribution Period and Benefit Period...................................................12 Benefits...........................................................................................13 Type Of Medical Benefits Provided.........................................................14 Full Medical Care ...............................................................................14 Expanded Medical Care........................................................................14 Immunization ...................................................................................14 Family Welfare Services ......................................................................14 Supply Of Special Aids.........................................................................15 Sickness Benefits...............................................................................15 Qualifying Conditions..........................................................................15 Sickness Benefits................................................................................15 Enhanced Sickness Benefits..................................................................18 Maternity Benefits..............................................................................19 Temporary disablement Benefit (TDB).....................................................19 Dependants’ Benefit(DB)......................................................................20 System of Treatment...........................................................................20 Scale of Medical Benefit.......................................................................21 Benefits to Retired IPs.........................................................................22 Administration of Medical Benefit in a State.............................................22 Domiciliary Treatment.........................................................................23 Specialists Consultation.......................................................................24 In-Patient treatment...........................................................................25 Imaging Services................................................................................26 Artificial Limbs & Aids.........................................................................26 Reimbursement.................................................................................27 What is Registration?....................................................................31Mumbai Facts and Figures..................................................33Data of the ESIS Hospitals in Mumbai.....................................34Data On The Working Of The ESIS Hospital, Mulund (W).............35 Total Area Covered......................................................................36 Staff Position Of ESI Hospital, Mulund ...............................................37 2
  3. 3. Beds Distribution Of The ESIS Hospital, Mulund (W)..............................38 Machines & Equipments in ESIS Hospital............................................39 Statement Showing OPD Attendance Of ESI Hospital, Mulund .................41 Statement Showing Operations at ESI Hospital, Mulund .........................41 Resident Quarters Position of ESI Hospital, Mulund ..............................44 Statement Showing Food Supply at ESI Hospital, Mulund........................45From the Kitchen.............................................................46 Diet chart of ESI Hospital, Mulund...................................................46Our Recommendations to the above problems........................49Special Initiatives.............................................................49Present Initiatives in working of ESIC....................................50Overview Of Healthcare Services In India...............................52 Healthcare Services.....................................................................52 Public Health System....................................................................56 Initiatives on Public Health Infrastructure in the XI Plan........................57Challenges before the healthcare sector in India......................58 Regulation.................................................................................58 Licensing...................................................................................59 ..............................................................................................60Skill Deficit in Healthcare .................................................61Indian Medical Professionals in Foreign Countries.....................62 Health Education.........................................................................63 Limited Coverage of Health Insurance...............................................64Responding To Challenges..................................................65 Regulation of clinical establishments and improving the quality of healthcare institutions................................................................................65 Expanding Health Insurance ...........................................................65 Medical Education .......................................................................66Concern: .......................................................................68Dead-end:......................................................................70Report Of The National Commission On Macroeconomics And Health....................................................................................71Analysis of effects made for evolving standards and developing anaccreditation system.........................................................73Ministry Level Infrastructure ..............................................76Regional Level Infrastructure..............................................77Regional Level Infrastructure..............................................78ESI Hospitals In Mumbai......................................................79ESI Branch Offices In Mumbai Region (Maharashtra)..................80Member Of Employeess State Insurance Corporation................85Photo Gallery .................................................................89 3
  4. 4. AcknowledgementAt the outset, it is my duty to acknowledge with `gratitudethe generous help that I received from all the offices andindividuals towards completion of this project. It was for theirproactive support that a survey work of this magnitude couldbe completed.Special thanks to the entire ESIS team under the guidance ofMr Acharya , AO and to Mr Gunje in particular. It was for theirunending support that the project team could finish its report ontime.Our heartfelt appreciation also goes to Mr Jandhlekar, Kitchen In-charge and Ms Mudras, Dietician providing timely information to theproject team.Dr. W A Dalvi, RMO deserves special mention for the support receivedfrom him 4
  5. 5. Objectives Of The Study:The Employees State Insurance Corporation (ESIC) of India is one ofthe largest social security organizations providing medical insurancecover and delivering of medical care to 35 million beneficiariesthrough 140 hospitals and 1500 dispensaries.The objectives of this study are to understand the working system ofESI hospital and suggest systems for e-governance to facilitate thecoordination between ESIC, ESIS and the beneficiaries. Towards this,we selected a large ESI hospital, namely, the ESIS Hospital at Mulund(W) and gained very useful insights about the systems currently inpractice for offering medical benefits to the insured persons and theirbeneficiaries. This working paper brings out our detailed analysis ofthe working of ESI hospital, Mulund in delivering medical care underthe ESI scheme. 5
  6. 6. Employee State Insurance CorporationThe Employees State Insurance Act (ESI Act), promulgated by the Indian Parliament in1948, provides a comprehensive social security for workers in the lower wage bracket.The ESI Act applies to non-seasonal, power using factories or manufacturing unitsemploying ten or more persons and non-power using establishments employing twenty ormore persons. Under the enabling provisions of the Act, a factory or establishment,located in a geographical area, notified for implementation of the scheme, falls in thepurview of the Act. Employees of the aforesaid categories of factories andestablishments, but drawing wages only up to Rs.6500/- a month, are entitled to healthinsurance cover under the ESI Act. The wage ceiling for purpose of coverage is revisedfrom time to time, to keep pace with rising cost of living and subsequent wage hikes.The present ceiling of Rs.6500/- has been effective from 1st January 1997.Employee State Insurance Scheme (ESIS) was first implemented in 1952 in two industrialunits at Kanpur and Delhi. Over the last four and a half decades, ESIS has emerged as thelargest multidimensional social security set up in Southeast Asia. As of now, the ESI Act isapplicable to over 250,000 industrial units in the country, benefiting about 87 lakhsfamily units of workers in the lower wage bracket, accounting for a total beneficiarypopulation of about 330 lakhs.ESIS guarantees full medical facilities to the beneficiaries and adequate cashcompensation to insured persons. Medical benefit comprises outpatient care, domiciliaryvisits, specialist and diagnostic services, hospitalization, super specialist treatment, freesupply of drugs, dressings, artificial aids and appliances, besides immunization and familywelfare service, etc. Cash benefits include benefits payable in cash on account of loss ofwages or earning capacity caused by sickness, temporary disablement, occupationaldisease, maternity or death or permanent disablement of an insured persondue to employment injury or an occupational disease.ESIS is a self-financing health insurance scheme. Contributions are raised from coveredemployees and their employers as a fixed percentage of wages. Covered employeescontribute 1.75% of the wages, whereas, the employers contribute 4.75% of the wages ofthe covered employees. Contributions are the same irrespective of the nature ofemployment or the industry. Employees, earning less than Rs.40/- a day as daily wage,are exempted from payment of their share of contribution. The contributions paid byemployees and employers are deposited in a common pool known as the ESI Fund. ESIfund is utilized for meeting the administrative expenses of the ESI scheme, as well as thecash and medical benefits to the insured persons and their dependants ESIS isadministered by a corporate body called Employees State Insurance Corporation (ESIC).The Union Minister of Labour heads the corporation as its Chairman. Its members includerepresentatives from the employers, employees, the central and state governments,medical professionals and members of the parliament. Certain important statistics ofESIC are given in Exhibit 1. Revenue receipts and expenditure of ESIC for the year 1999-2000 are given in Exhibit 2. 6
  7. 7. ESIC has set up a large number of hospitals, dispensaries, and diagnostic centres acrossthe country for delivering primary, outpatient, and inpatient healthcare services. ESIC isone of the few organizations wherein the concept of a proper referral system is adheredto. Those seeking medical attention under the scheme are required to first consult theirdoctor at the designated dispensaries. The doctors at the dispensaries would if requiredrefer the patients for indoor treatment. Patients, who are advised to undergo indoortreatment, have the option to choose any ESI hospital or an ESI approved hospitalaccording to their preferences, except in the case of super specialty treatment which areavailable under the scheme only at a few designated hospitals. Clinical investigationservices, outpatient and inpatient treatments, as well all the prescribed medicines anddrugs are offered free of charge to the insured persons and their beneficiaries.Delivery of medical care under the scheme is the responsibility of the state governments,except in Delhi and Noida (UP) where ESIC itself is offering the medical care. Theexpenditure incurred on provision of medical benefit is shared by the corporation and thestate governments in the ratio of 7:1 within the prescribed per capita ceiling onexpenditure. From 1-4-99, ESIC has fixed the ceiling of expenditure for medical facilitiesper insured person family unit at Rs. 600.This ceiling of Rs. 600 is further divided into the following four categories ofexpenditure:• A maximum of Rs. 170 per Insured Person (IP) family unit per annum for drugs anddressings• A maximum of Rs. 20 per IP family unit per annum for maintenance and repair ofmedical equipments• A maximum of Rs. 50 per IP family unit per annum for expenditure to be incurredtowards reimbursement of super specialty services not available in ESI institutions,• A maximum of Rs. 360 per IP family unit per annum towards salaries and administrativeexpenses.Amount spent by a State Government (on medical benefits) beyond this per capita limit isborne by the State Government itself. A comparison of medical benefits across all thestates and union territories is given in Exhibit 3. 7
  8. 8. ESI SchemeEmployees’ State Insurance Scheme of India is an integrated social security schemetailored to provide social protection to workers and their dependants, in the organisedsector, in contingencies, such as, sickness, maternity and death or disablement due to anemployment injury or occupational hazard.The ESI Act, (1948) applies to following categories of factories and establishments in theimplemented areas:- • Non-seasonal factories using power and employing ten(10) or more persons • Non-seasonal and non power using factories and establishments employing twenty (20) or more persons.The "appropriate Government" State or Central is empowered to extend the provisions ofthe ESI Act to various classes of establishments, industrial, commercial or agricultural orotherwise. Under these enabling provisions most of the State Govts have extended theESI Act to certain specific class of establishments, such as, shops, hotels, restaurants,cinemas, preview theatres, motors transport undertakings and newspaper establishmentsetc., employing 20 or more persons. The ESI Scheme is mainly financed by contributionsraised from employees covered under the scheme and their employers, as a fixedpercentage of wages. Employees of covered units and establishments drawing wages uptoRs.10,000/- per month come under the purview of the scheme for social securitybenefits. However, employees’ earning upto Rs.50/- a day as wages are exempted frompayment of their part of contribution. The State Govts bear one-eighth share ofexpenditure on Medical Benefit within the per capita ceiling of Rs.900/- per annum andall additional expenditure beyond the ceiling.Employees covered under the scheme are entitled to medical facilities for self anddependants. They are also entitled to cash benefits in the event of specifiedcontingencies resulting in loss of wages or earning capacity. The insured women areentitled to maternity benefit for confinement. Where death of an insured employeeoccurs due to employment injury, the dependants are entitled to family pensionCorporationThe Employees’ State Insurance Scheme is administered by a corporate body called theESI Corporation.The Corporation is the highest policy making and decision taking authority under the ESIAct and oversees the functioning of the Scheme. The Corporation meets periodically toconduct business as may be required to regulate the functioning of the Scheme. 8
  9. 9. Constitution of CorporationThis apex body is constituted and notified by the Central Government for a four yearterm and represents various interest groups comprising employees, employers, theCentral and State Governments besides the parliament and medical profession. UnionMinister of Labour functions as the Chairman of the Corporation whereas, DirectorGeneral ESIC, is also an ex-officio member of the Corporation.StatementTo provide for certain benefits to Employees in case of sickness, maternity andemployment injury and to make provisions for related matters. 9
  10. 10. Coverage Under The ESI Act, 1948The Act was originally applicable to non-seasonal factories using power and employing 20or more persons; but it is now applicable to non-seasonal power using factoriesemploying 10 or more persons and non-power using factories employing 20 or morepersons.Under Section 1(5) of the Act, the Scheme has been extended to shops, hotels,restaurants, cinemas including preview theatre, road motor transport undertakings andnewspaper establishment employing 20 or more persons.The existing wage-limit for coverage under the Act, is Rs.10,000/- per month (with effectfrom 1.10.2006).Areas CoveredThe ESI Scheme is being implemented area-wise by stages. The Scheme has already beenimplemented in different areas in the following States/Union TerritoriesStatesAll the States except Nagaland, Manipur, Tripura, Sikkim, Arunachal Pradesh andMizoram.Union TerritoriesDelhi, Chandigarh and PondicherryCoverage :Coverage(As on 31st March, 2006) No. of Insured Person family units 91,48,605 No. of Employees 84,00,526 Total No. of Beneficiaries 3,54,96,589 No. of Insured women 15,43,250 No. of Employers, etc 3,00,718 10
  11. 11. FinanceThe Scheme is mainly financed by contributions from employers and employees. Theemployers’ contribution is equal to four and three fourth per cent of the wages payableto employees. The employees’ contribution is at the rate of one and three-fourth percent of the wages payable to an employee. The State Governments share expenditure onthe provision of medical care. Income / Expenditure Account 1 : INCOME Amount (Rs. in lakhs) : Actuals for 2000-2001 1,56,428.23 : Actuals for 2001-2002 1,73,019.26 : Actuals for 2002-2003 1,70,481.05 : Actuals for 2003-04 1,97,564.00 : Actuals for 2004-05 2,24,606.05 : Actuals for 2005-06 2,41,061.77 2 : BENEFIT EXPENDITURE : Actual Expenditure for 2000-01 82,870.08 : Actual Expenditure for 2001-02 84,431.19 : Actual Expenditure for 2002-03 85,161.16 : Actual Expenditure for 2003-04 89,515.84 : Actual Expenditure for 2004-05 95,110.00 3 : TOTAL EXPENDITURE : Actual expenditure for 2000-01 1,08,258.14 : Actual expenditure for 2001-02 1,10,412.04 : Actual expenditure for 2002-03 1,11,832.00 : Actual expenditure for 2003-04 1,17,048.00 : Actual expenditure for 2004-05 1,25,819.53 : Actual expenditure for 2005-06 1,27,896.16 11
  12. 12. ContributionE.S.I. Scheme being contributory in nature, all the employees in the factories orestablishments to which the Act applies shall be insured in a manner provided by the Act.The contribution payable to the Corporation in respect of an employee shall comprise ofemployer’s contribution and employee’s contribution at a specified rate. The rates arerevised from time to time. Currently, the employee’s contribution rate (w.e.f. 1.1.97) is1.75% of the wages and that of employer’s is 4.75% of the wages paid/payable in respectof the employees in every wage period. Employees in receipt of a daily average wageupto Rs.50/- are exempted from payment of contribution. Employers will howevercontribute their own share in respect of these employees.Collection of ContributionAn employer is liable to pay his contribution in respect of every employee and deductemployees contribution from wages bill and shall pay these contributions at the abovespecified rates to the Corporation within 21 days of the last day of the Calendar month inwhich the contributions fall due. The Corporation has authorized designated branches ofthe State Bank of India and some other banks to receive the payments on its behalf.Contribution Period and Benefit PeriodThere are two contribution periods each of six months duration and two correspondingbenefit periods also of six months duration as under.Contribution period Corresponding Cash Benefit period1st April to 30th Sept. 1st January of the following year to 30th June.1st Oct. to 31st March 1st July to 31st December of the year following 12
  13. 13. BenefitsThe section 46 of the Act envisages following six social security benefits :-(a) Medical Benefit(b) Sickness Benefit(SB) Extended sickness Benefit(ESB) Enhanced Sickness Benefit(c) Maternity Benefit(MB)(d) Disablement Benefit Temporary disablement benefit(TDB) Permanent disablement benefit(PDB)(e) Dependants’ Benefit(DB)(f) Funeral ExpensesAn interesting feature of the ESI Scheme is that the contributions are related to thepaying capacity as a fixed percentage of the workers wages, whereas, they are providedsocial security benefits according to individual needs without distinction.Cash Benefits are disbursed by the Corporation through its Local Offices LOs/ Mini LocalOffices (MLOs)/Sub Local Offices SLOs)/pay offices, subject to certain contributoryconditions.In addition, the scheme also provides some other need based benefits to insuredworkers.These includes : i. Rehabilitation allowance ii. Vocational Rehabilitation iii. Unemployment Allowance (Under Rajiv Gandhi Shramik Kalyan Yojana) 13
  14. 14. Type Of Medical Benefits ProvidedThe Employees’ State Insurance Scheme provides full medical care in the form of medicalattendance, treatment, drugs and injections, specialist consultation and hospitalizationto insured persons and also to members of their families where the facility for Specialistconsultation, hospitalization has been extended to the families.For the families, this benefit has been divided into two categories as under:-Full Medical CareThis consists of hospitalization facilities and includes specialist services, drugs anddressings and diets as required for in-patients.Expanded Medical CareThis consists of consultation with the specialists and supply of special medicines anddrugs as may be prescribed by them in addition to the out-patient care. This alsoincludes facilities for special laboratory tests and X-Ray examinations.Apart from the curative services provided through hospitals and dispensaries, theCorporation also provides the following facilities including family welfare services.ImmunizationThe Corporation has embarked upon a massive programme of immunization of youngchildren of insured persons. Under this programme, preventive inoculation and vaccinesare given against diseases like diphtheria, pertusis, polio, tetanus, measles, mumps,rubella, tuberculosis etc.Family Welfare ServicesAlong with the immunization programme, the Corporation has been undertaking provisionof family Welfare Services to the beneficiaries of the Scheme. The Corporation hasorganized these services in 180 centres besides reserving 330 beds in hospitals forundertaking tubectomy operations. So far, 828976 sterilization operation viz. 176197vasectomies and 652779 tubectomies have been performed upto 31.3.1999. The ESICorporation has also extended additional cash incentive to insured persons to promoteacceptance of sterilization method by providing sickness cash benefit equal to full wagefor a period of 7 days for vasectomy and 14 days for tubectomy. The period for whichcash benefit is admissible is extended beyond the above limits in the event of anycomplications after Family Planning operations. 14
  15. 15. Supply Of Special AidsInsured persons and members of their families are provided artificial limbs, hearing aids,and artificial appliances like spinal supports, cervical collars, walking calipers, crutches,wheel chairs and cardiac pace makers as a part of medical care under the Scheme.Sickness BenefitsSickness Benefit represents periodical cash payments made to an IP during the period ofcertified sickness occurring in a benefit period when IP requires medical treatment andattendance with abstention from work on medical grounds. Prescribed certificates are;Forms 8,9,10,11 & ESIC-Med.13. Sickness benefit is roughly 50% of the average dailywages and is payable for 91 days during 2 consecutive benefit periods.Qualifying Conditions(i)To become eligible to Sickness Benefit, an IP should have paid contribution for not lessthan 78 days during the corresponding contribution period.(ii)A person who has entered into insurable employment for the first time has to wait fornearly 9 months before becoming eligible to sickness benefit, because his correspondingbenefit period starts only after that interval.(iii)Sickness Benefit is not payable for the first two days of a spell of sickness except incase of a spell commencing within 15 days of closure of earlier spell for which sicknessbenefit was last paid. This period of 2 days is called "waiting period". This provisionshould be clearly understood by IMOs/IMPs as actual experience shows that such of IPswho want to avail medical leave on flimsy grounds generally come for FirstCertificate/First & Final Certificate within 15 days of earlier spell, usually on unpaidholidays and/or on each weekly off etc, to avoid loss of benefit for 2 days due to freshwaiting period.Sickness BenefitsExtended Sickness BenefitEnhanced Sickness Benefit 15
  16. 16. Extended Sickness BenefitIPs suffering from long term diseases were experiencing great hardship on expiry of 91days Sickness benefit. Often they, though not fit for duty, pressed for a Final certificate.Hence, a provision for paying Sickness Benefit for an extended period (Extended SicknessBenefit)of upto 2 years in a ESB period of 3 years.1. An IP suffering from certain long term diseases is entitled to ESB, only after exhaustingSickness Benefit to which he may be eligible. A common list of these long term diseasesfor which ESB is payable, is reviewed by the Corporation from time to time. The list waslast reviewed on 5.12.99 and revised provisions of ESB became effective from 1.1.2000and at present this list includes 34 diseases which are grouped in 11 groups as perInternational Classification of diseases and theo names of many existing diseases havebeen changed as under :-I Infectious Diseases 1. Tuberculosis 2. Leprosy 3. Chronic Empyema 4. AIDS II Neoplasms 5. Malignant Diseases III Endocrine, Nutritional and Metabolic Disorders 6. Diabetes Mellitus-with proliferative retinopathy/diabetic foot/nephropathy. IV Disorders of Nervous System 7. Monoplegia 8. Hemiplegia 9. Paraplegia 10. Hemiparesis 11. Intracranial Space Occupying Lesion 12. Spinal Cord Compression 13. Parkinson’s disease 14. Myasthenia Gravis/Neuromuscular Dystrophies V Disease of Eye 15. Immature Cataract with vision 6/60 or less 16. Detachment of Retina 17. Glaucoma 16
  17. 17. VI Diseases of Cardiovascular System 18. Coronary Artery Disease:- a. Unstable Angina b. Myocardial infraction with ejection less than 45% 19. Congestive Heart Failure- Left , Right 20. Cardiac Valvular Diseases with failure/complications 21. Cardiomyopathies 22. Heart disease with surgical intervention alongwith complications VII Chest Diseases 23. Bronchiectasis 24. Interstitial Lung Disease 25. Chronic Obstructive Lung Diseases (COPD) with congestive heart failure (Cor Pulmonale) VIII Diseases of the Digestive System 26. Cirrhosis of liver with ascities/chronic active hepatitis IX Orthopaedic Diseases 27. Dislocation of vertebra/prolapse of intervertebral disc 28. Non union or delayed union of fracture 29. Post Traumatic Surgical amputation of lower extremity 30. Compound fracture with chronic osteomyelitis X Psychoses 31. Sub-group under this head are listed for clarification a. Schizophrenia b. Endogenous depression c. Manic Depressive Psychosis (MDP) d. DementiaXI Others 32. More than 20% burns with infection/complication 33. Chronic Renal Failure 34. Reynaud’s disease/Burger’s disease. 17
  18. 18. 1. In addition to the above list, Director General/Medical Commissioner are authorised tosanction ESB for a maximum period upto 730 in cases of rare but treatable diseases orunder special circumstances, such as, adverse reaction to drugs which have not beenincluded in the above list, depending on the merits of each case, on therecommendations of RDMC/AMO or either authorised officers runniong the medicalscheme.2. To be entitled to the Extended Sickness Benefit an Insured Persons should have been incontinuous employment for 2 years or more at the beginning of a spell of sickness inwhich the disease is diagnosed and should also satisfy other contributory conditions.3. ESB shall be payable for a period of 124 days initially and may be extended up to 309days in chronic suitable cases by Regional Dy. Medical Commissioner/MedicalReferee/Administrative Medical Officer/Chief Executive of the E.S.I. Scheme in the Stateor his nominee on the report of the specialist(s).Enhanced Sickness BenefitsIt was introduced w.e.f 1.8.1976 as an incentive to IPs/IWs for undergoing Vasectomy/Tubectomy. Insured Persons eligible to ordinary sickness benefit are paid enhancedsickness benefit at double the rate of sickness benefit i.e., about full average daily wagefor undergoing sterilisation operations for family welfare. Duration of enhanced SicknessBenefits is upto 7 days in the case of Vasectomy and upto 14 days in the case of theTubectomy from the date of operation or from the date of admission in the hospital asthe case may be. The period is extendable in case of post operative complications. 18
  19. 19. Maternity BenefitsMaternity Benefit is payable to an Insured Woman in the following cases subject tocontributory conditions:-Confinement-payable for a period of 12 weeks (84 days) on production of Form 21 and23.Miscarriage or Medical Termination of Pregnancy (MTP)-payable for 6 weeks (42 days)from the date following miscarriage-on the basis of Form 20 and 23.Sickness arising out of Pregnancy, Confinement, Premature birth-payable for a period notexceeding one month-on the basis of Forms 8, 10 and 9.In the event of the death of the Insured Woman during confinement leaving behind achild, Maternity Benefit is payable to her nominee on production of Form 24 (B).Maternity benefit rate is double the Standard Benefit Rate, or roughly equal to theaverage daily wage.Temporary disablement Benefit (TDB)(a) TDB is payable to an employee who suffers employment injury (EI) or OccupationalDisease and is certified to be temporarily incapable to work. "Employment Injury" hasbeen defined under Section 2(8) of the Act, as a personal injury to an employee causedby accident or occupational disease arising out of and in the course of his employment,being in insurable employment, whether the accident occurs or the occupational diseaseis contracted within or outside the territorial limits of India.(b) Certificates Required for TDB: Accident Report in form 16, Form 8,9,10, 11 and ESIC Med.13.(c ) Eligibility for TDB : The benefit is not subject to any contributory conditions. An IP is eligible from the day he joins the insurable employment. (d) TDB Rate is 40% over and above the normal sickness benefit rate. This works out to nearly 85% of the average daily wages. 19
  20. 20. (d) Duration of TDB :There is no prescribed limit for the duration of TDB. This is payable as long as temporarydisablement lasts and significant improvement by treatment is possible. If a TemporaryDisablement spell lasts for less than 3 days (excluding day of accident), IP will be paidsickness benefit, if otherwise eligible. A special point for IMOs/IMPs is that some IPs mayresist taking a Final Certificate especially before 3 days for fear of loss of TDB.Dependants’ Benefit(DB)The dependants’ benefit is payable to the dependants as per Section 52 of the Act readwith provision of 6(A) of Section 2 in cases where an IP dies as result of EI. The age ofdependants, has to be determined either by production ofDocumentary evidence as specified in Regulation 80(2) orAge certified by Medical Officer In charge of Government Hospital or Dispensary.The minimum rate of DB w.e.f 1.1.90 is Rs.14/- per day and these rates of the DB areincreased from time to time. The latest enhancement is with effect from 01.08.2002System of TreatmentGenerally, the allopathic system of medicine is used for providing Medical Benefit.However, where a substantial number of workers demand treatment by Indian system ofmedicine and Homoeopathy (ISM & H) other than Allopathy and where the StateGovernment has recognised the qualifications in such system, treatment facilities may beprovided under the ISM & H as well. The various ISM &H systems of treatment in vogueare:, Ayurvedic, Unani, Sidha, Yoga therapy and Homeopathy.Certificates required for the purpose of Cash Benefits in respect of persons treated byISM &H should be issued by IMO /IMP having recognised qualifications in such system andduly appointed by the State Government. The issue of certificates under ISM &H ispossible only where dispensaries in systems other than allopathic medicine arefunctioning independently with IPs and their family units attached to them and notfunctioning merely as referral units. In places where ISM &H units function only asreferral centres, certificates will have to be issued by the Allopathic dispensary to whichthe IP is attached. 20
  21. 21. Scale of Medical BenefitThe scale of Medical Benefit under section 57 of Act to be provided to the IPs andmembers of their families is to be prescribed by State Government in consultation withthe Corporation under Section 58(1 & 3) of Act under State Medical Benefit Rules. An IPand/or a member of his family does not have the right to claim Medical Services over andabove those which have been so prescribed. The beneficiaries are entitled to reasonablemedical, surgical and obstetric treatment. a. To Insured Persons:- IPs are entitled to avail treatment in ESI Dispensary/Hospital/Diagnostic Centre and recognised institutions, to which he is attached such as:- • Outpatient treatment • Domiciliary treatment by visits at their residences. • Specialists Consultation. • In-patient treatment(Hospitalisation) • Free supply of drugs dressings and artificial limbs, aids and appliances. • Imaging and laboratory services. • Integrated family welfare, immunisation and MCH Programme and other national health programme etc. • Ambulance service or re-imbursement of conveyance charges for going to hospitals, diagnostic centres etc. • Medical Certification and • Special provisions. b. To Family Members of Insured Persons:- While in all implemented areas, IPs are entitled to medical care as detailed above, members of a family of an IP are entitled to one or other of the following scales of Medical Benefits:- i. "FULL" Medical Care i.e., all facilities as for IPs including hospitalisation. ii. "EXPANDED" Medical Care i.e., all facilities as for IPs except hospitalisation. A small number of IPs in the States of Gujarat and Bihar fall under this category.The Corporation aims at providing uniform scale of Medical Care to the Family membersin all implemented areas as the rates of the contribution paid by the employees and theemployers are the same throughout the country. 21
  22. 22. Benefits to Retired IPsMedical Benefit to Retired Insured Persons and Permanent Disabled Insured Persons:-On payment of Rs.10/- P.M. in lump sum for one year in advance, Medical Benefit can beprovided (under Section 56 of the Act) to: i. An Insured Person and his or her spouse who leaves insurable employment on attaining the age of superannuation after being insured for not less than five years, till the period for which contribution is paid. ii. An Insured Person and his/her spouse who ceases to be in insurable employment on account of permanent disablement due to employment injury shall be entitled to medical benefit.Administration of Medical Benefit in a StateThe administration of Medical Benefit under the ESI Scheme is the statutory responsibilityof the State Government except in the Union Territory of Delhi where the ESIC has takenover direct responsibility to administer the same with effect from 1.4.1962. TheCorporation has also taken the responsibility of directly administering the existingOccupational Disease Centres at Delhi. Mumbai, Calcutta, Chennai and Nagda as well asthe Scheme in the Industrial pocket of Uttar Pradesh i.e., Noida and Greater Noida. 22
  23. 23. Domiciliary TreatmentAn Insured Person and his family members are entitled to free medical attendance byIMO/IMP at their residence when the condition of the patient is such that he/she cannotreasonably be expected to attend the dispensary/clinic.Conveyance allowance for Domiciliary visit i. For the domiciliary visit, the IMO’s are paid conveyance allowance. The quantum of this allowance is decided by the State Government in consultation with the Corporation. ii. The IMPs are not paid any domiciliary conveyance allowance. In their case, it is included in the capitation fee upto a distance of 5 km. between the Clinic of IMP and IP’s residence.The IMOs/IMPs are required to maintain record of domiciliary visits in a register month-wise. The columns in this register are given under the Chapter "Sickness Absenteeism andRecording". 23
  24. 24. Specialists ConsultationThe standard of Medical Care under the E.S.I. Scheme provides for specialist consultationto IP in all cases and to members of their families in areas with "Expanded" and "Full"Medical Care. Arrangements for specialist consultation may be provided atSpecialist/Diagnostic Centres, E.S.I. Hospitals or at such other institutions by appointingSpecialists/Super Specialists on full time/part-time basis where suitable arrangementsexist. Such consultation is provided in the following specialities:- 1. General Medicine 14. Psychiatry 2. General Surgery 15. Critical Care Services 3. Pulmonary Medicine 16. Cardiology (Tuberculosis and Chest Diseases) 17. Neurology 4. Obstetrics and Gynaecology 18. Urology and Nephrology 5. Pathology 19. Gastro-enterology 6. Paediatrics 20. Endocrinology 7. Eye 21. Oncology 8. Ear, Nose and Throat Diseases 22. Burns and Plastic Surgery 9. Skin and STD 23. Cardio Thoracic Surgery 10. Radiology 24. Neurosurgery 11. Orthopaedics Rehabilitation Services 25. Occupational Medicine (Physiotherapy and Occupational 26. Laboratory Services Therapy) 27. Blood Transfusion Services 28. Haematological Services 12. Dental 29. AnaesthesiologyIt may not be necessary to appoint specialists in all specialities at all centres. However,specialists in the first 13 specialities mentioned above may be made available in eachdiagnostic Centre and emergency centres as far as possible. The other specialities may beprovided as per disease profile of the area/as per requirement. 24
  25. 25. In-Patient treatmentUnder the E.S.I. Scheme, IPs in all areas and their family members in areas with "Full"medical care facility are entitled to hospitalisation.In-patient treatment is provided at hospitals constructed by E.S.I.C or by reservation ofbeds in the hospitals owned by the State Government, local Fund Organisation or PrivateBodies or by constructing annexes to such institutions. The E.S.I. Scheme pays for thesebeds on the basis of occupied bed days. The Corporation has framed standard plans forconstruction of different sizes of hospitals/annexes mainly with a view to achievinguniformity and standardisation all over the country.The Corporation has also laid down norms for equipment and staff for hospitals ofdifferent bed strengths.Drugs and DressingsUnder the E.S.I. Scheme, IPs in all areas and their family members in areas with "Full"medical care facility are entitled to hospitalisation.In-patient treatment is provided at hospitals constructed by E.S.I.C or by reservation ofbeds in the hospitals owned by the State Government, local Fund Organisation or PrivateBodies or by constructing annexes to such institutions. The E.S.I. Scheme pays for thesebeds on the basis of occupied bed days. The Corporation has framed standard plans forconstruction of different sizes of hospitals/annexes mainly with a view to achievinguniformity and standardisation all over the country.The Corporation has also laid down norms for equipment and staff for hospitals ofdifferent bed strengths.Drugs and DressingsAll drugs and dressings (including vaccines and sera) that may be considered necessaryand generally in accordance with the E.S.I.C drug formulary are supplied free of charge.There are two parts in E.S.I.C Drug Formulary, 1998 as follows:-Part-I:- List of medicines for emergency kit for (a) dispensary (b) hospitalPart II:- List of medicines to be supplied by dispensaries in Service Areas or by approvedchemists or depots on prescription in panel areas. 25
  26. 26. Imaging ServicesImaging Services and Laboratory InvestigationsImaging and investigations including CT Scan, MRI, Echocardiography and laboratoryfacilities are provided free of cost to IPs and their families at state level specialityhospitals or other institutions having tie up with E.S.I. Scheme.Artificial Limbs & AidsArtificial Limbs, Aids, and AppliancesInsured Persons and their family members are provided following artificial limbs, aids andappliances as part of medical care under the E.S.I. Scheme.:- • Artificial limbs • Hearing Aids • Spectacles (Frame costing not more than RS. 100/- and replacement of frames not to be made earlier than 5 years) (To insured persons only) • Artificial Dentures, teeth (To insured persons only) • Artificial Eye (To insured persons only) • Wigs (replacement not earlier than 5 years) to female beneficiaries only • Cardiac pacemaker • Wheel Chair/tricycle • Spinal supports (jackets, braces etc.) • Cervical collars • Walking callipers, surgical boots etc. • Crutches • Hip prosthesis, total hip • Intra ocular lens (IOL) • Any other aid or appliances prescribed by the specialist as part of treatment.The expenditure on artificial limbs, aids and appliances is met from the shareable pool ofexpenditure on medical care. 26
  27. 27. ReimbursementUnder Regulation 69, every employer has to arrange for First-aid Medical care andtransport of accident cases till the injured IP is seen by the IMO/IMP and such employer isentitled to reimbursement of expenses incurred in this regard upto the maximum of scaleprescribed from time to time. However, reimbursement is not permissible, if theemployer is required to provide such medical aid free of charge under any otherenactment.The cost of provision of such emergency treatment would be reimbursed to the employerby the Director/AMO (ESI Scheme) of the respective State and, therefore, all claims dulysupported by relevant receipts and vouchers should be sent to him for verification andpayment.Reimbursement of expenses incurred in respect of medical treatment underregulation-96 A.Regulation-96 A reads as follows:- Claims for reimbursement of expenses incurred inrespect of medical treatment of IP and his family may be accepted in circumstances andsubject to such conditions as the Corporation may by general or special order specify.The following conditions have been laid down under this Regulation :- a. Full authority is vested with the State Government concerned to reimburse expenditure in respect of medical treatment of IP and his family. b. It may be left to the discretion of the State Government to decide the Authority within their machinery who will approve the expenditure in question; and c. Time limit for submission of the claims for reimbursement is one year.The State Government has to keep in view the following points while considering thecases of reimbursement of expenditure on Medical Care: i. Whether such facilities for which reimbursement is recommended are not available with the State; ii. Whether the hospital where the IP was sent or proposed to be sent was/is the nearest hospital having required facilities/services.A List of Types of cases for which reimbursement is permitted is given below:- 1. Reimbursement is permissible in case of failure of the mobile dispensary van due to technical defects or otherwise to adhere to its schedule timings or where IP attached to such a dispensary sustained serious injuries or suffered from serious illness during off hours of the dispensary. 2. IPs and their family members had to resort to private treatment during the off hours of ESI dispensary/Emergency Centre due to unavoidable circumstances. 3. Medicines prescribed by IMO/Specialist were out of stock in the ESI Dispensary/Approved Chemist thereby compelling the IPs to make purchases from the market. 27
  28. 28. 4. Medicines prescribed by Specialist and not provided by the IMO/IMP and where specialist considered such special Medicines absolutely necessary for the treatment of the beneficiaries as no substitute medicine was considered equally efficacious whether as an out patient or in patient.5. Special appliances prescribed by Specialist such as Spinal supports, Cervical Collars, Walking Callipers, and Crutches, etc. if considered necessary as part of the treatment.6. Where an IMO/IMP failed to make domiciliary visit requested by an IP thereby compelling the IP to make private arrangement for treatment. Under the panel system such cost is recoverable from the IMP if recommended after investigation by the Medical Service Committee.7. Serious cases of accident or illness admitted directly into recognised hospitals where owing to the clinical condition of the patient, being unconscious or otherwise, it was not possible to reveal his identity as an ESI patient and the hospital authorities recovered hospital expenses directly from the patient or the employer.8. Serious cases of accident/illness where a beneficiaries was admitted directly at a private hospital or in a non-recognised hospital where admission in a hospital recognised under the scheme would have seriously jeopardised his health like sudden heart attacks, fracture of the spine, cerebral haemorrhage, etc.9. Expenditure incurred on investigation for blood transfusion.10. Mental cases that may have incurred expenditure either as an out patient on specialised Therapy such as ECT etc.11.Serious cases of accident and illness admitted to recognised hospitals where all the reserved ESI beds were occupied. 28
  29. 29. 1. Reimbursement of conveyance charges incurred by IP where ambulance or any other transport under the scheme is not available owing to some reason or the other and where in the opinion of the IMO/IMP such a patient was non- ambulatory. 2. In respect of Specialised examination, laboratory test, X-ray, other imaging services etc., recommended by specialist, but where the IP either due to the break down in the machinery or where the nature of the examination of the Laboratory Tests was such that it was beyond the scope of the facilities available in the recognised laboratory/hospital. 3. In addition to above types of cases, reimbursement may also be allowed in other cases depending upon the merits of each case and the circumstances under which expenditure was incurred.Reimbursement of Conveyance ChargesIn the absence of availability of an ambulance and where needed in an emergency, anyother quick form of transport may be used and amount so spent subject to the maximumrate prescribed by the Government/Transport authority (both ways) is reimbursed to IPs.To avoid hardship to IP and his family who have to go to any hospital or medicalinstitution for admission, specialist consultation or investigation, but whose condition isnot such as to need an ambulance, provision has been made for the payment ofconveyance charges, if hospital/medical institution to which the case is referred to, is atan out-station or is at a distance of more than 8 kms from the ESI Dispensary or the clinicof the panel doctor. The charges are restricted to actual IInd class railway fare or cost ofa single seat in public conveyance both ways whichever is feasible.If the beneficiary is not in a fit condition to travel without escort for reasons to berecorded and so certified by IMO/IMP, the conveyance charges are also allowed for anescort.The IMO/IMP should keep a separate account of such payments in the prescribed Registerand send a quarterly statement of this expenditure to the Director/AMO by the 15 th ofthe month following the quarter ending in March, June, Sept. and December. The returnsreceived from different areas in the State may be consolidated area-wise by theDirector/ AMO and quarterly statement sent to the Corporation.The expenditure on conveyance charges forms part of the Medical Care under the E.S.I.Scheme and hence shareable between the Corporation and the State Government in theusual ratio within ceiling prescribed. 29
  30. 30. FormsForm01 : Employers Registration Form (Word Format) (PDF Format)Form01(A) : Form of Annual Information on Factory/Establishment (Word Format)Form1 : Declaration Form (Word Format) (PDF Format)Form1A : Family Declaration FormForm1B : Changes in Family Declaration FormForm3 : Return of Declaration FormsForm4 : Identity CardForm4(A) Family Identity CardForm5 Return of ContributionsForm7 FIRST/INTERMEDIATE/FINAL CERTIFICATEForm8 SPECIAL INTERMEDIATE CERTIFICATE Abstention verification in r/o Sickness Benefit/TemporaryForm10 Disablement Benefit/MBForm12 Sickness of Temporary Disablement BenefitForm12A Maternity Benefit for SicknessForm13 Sickness or Temporary disablement or maternity benefit for sicknessForm13A Maternity benefit for sicknessForm14 Sickness or temporary disablement or maternity benefit for sicknessForm14A Maternity Benefit for SicknessForm16 Accident report from employerForm17 Dependants or funeral benefit (Death Certificate)Form18 Dependants Benefit (Claim Form)Form18A Dependants Benefit ( Claim for periodical payments)Form19 Maternity Benefit ( Notice of Pregnancy)Form20 Maternity Benefit ( Certificate of Pregnancy)Form21 Maternity Benefit (Cetificate of expected confinement)Form22 Claim for Maternity BenefitForm23 Maternity Benefit (Certificate of confinement or miscarriage)Form24 Maternity Benefit (Notice of work)Form25 Claim for Permanent Disablement BenefitForm26 Certificate for permanent disablement benefitForm27 Declaration and certificate for depenants benefit 30
  31. 31. What is Registration?Registration is the process by which every employer/factory and its every employeeemployed for wages, is identified for the purpose of the Scheme, and their individualrecords are set up for them.The first step in the process is the obtaining of particulars about each coverablefactory/shop/establishment, and its identification by allotment of a number i.e. CodeNo. by the R. O. so as to facilitate keep track of contributions payable/paid and theconnected obligations of the employers. Subsequent step is the registration of employeesof covered factories by the R. O/L. O. (where the work of registration of employees isdecentralised), and identifying them by allotment of a number i.e., insurance number,and setting up of necessary records for recording the benefits for which the insuredemployee may be entitled under the Scheme according to eligibility. Individual record ofeach employer/employee will facilitate necessary changes in future from time to timeand proper watch for obtaining compliance from the employers and benefits toconcerned insured persons.Registration of Employers1.2 Section 2A of the ESI Act states as under:-2A. Registration of factories and establishments-Every factory or establishment to whichthis Act applies shall be registered within such time and in such manner as may bespecified in the regulations made in this behalf.1.3. As a follow-up of this provision in the Act, Regulation 10B was inserted in the ESI(General) Regulations, 1950. This regulation states as under: -10B- Registration of factories or establishments. -(a) The employer in respect of a factory or establishment to which the Act applies for thefirst time and to which an Employers’ Code No. is not yet allotted, and the employer inrespect of a factory or an establishment to which the Act previously applied but hasceased to apply for the time being, shall furnish to the appropriate R. O. not later than15 days after the Act becomes applicable, as the case may be, to the factory orestablishment, a declaration of registration in writing in form 01(hereinafter referred toas employers’ registration form).(b) The employer shall be responsible for the correctness of all the particulars andinformation required to be furnished on the employer’s registration form.(c) The appropriate Regional Office may direct the employer who fails to comply with therequirements of paragraph (a) of this regulation within the time stated therein, tofurnish to that office employer’s registration form duly completed within such furthertime as may be specified and such employer shall, thereupon, comply with theinstructions issued by that office in this behalf. 31
  32. 32. (d) Upon receipt of the completed employer’s registration form, the appropriate R. O.shall, if satisfied that the factory or the establishment is one to which the Act applies,allot to it an employer’s code number (unless the factory or the establishment hasalready been allotted an employer’s code number) and shall inform the employer of thatnumber.(e) The employer shall enter the employer’s code number on all documents prepared orcompleted by him in connection with the Act, the rules and these regulations and in allcorrespondence with the appropriate office.EMPLOYERS CAN NOW SUBMIT APPLICATION ONLINE FOR REGISTRATION UNDER ESIACT 32
  33. 33. Mumbai Facts and FiguresCivic Statistics (2005-2006) City W.Subs E.subs TotalTotal No. of Properties 64032 121228 77295 262555Rateable Value of all the 529.26 871.85 2985.75 1699.86PropertiesRate of R.V. per Head 1590.88 1784.28 807.15 4182.32Total Length of Roads in Kms 506.46 927.65 507.05 1941.16Fire Stations 15 12 6 33Private Markets 11 4 1 16Municipal Markets 43 65 30 138Mumbai Census PopulationYear Population1961 41,52,0561971 59,70,5751981 82,43,4051991 99,25,891Mumbai 2001, 2004, 2005 & 2006 **Population 2001 Census = 1,19,78,450MidYear Estimated Population 2004 = 1,26,61,952MidYear Estimated Population 2005 = 1,28,67,208MidYear Estimated Population 2006 = 1,30,72,464Year 2001 2004 2005 2006Number of Births 1,88,417 1,85,729 1,84,171 1,79,861Crude Birth Rate (@ 1000 15.72 14.67 14.31 13.76Population)Number of Deaths 85,051 86,433 87,128 90,113Crude Death Rate (@ 1000 7.10 6.83 6.8 6.89Population)Number of Infant Deaths 7,255 6,505 6,469 6,21Infant Mortality Rate (@1000 Birth) 38.5 35.02 35.12 34.57Neo Natal Deaths 4,392 3,981 3,924 3,922Neo-Natal Death Rate (@1000 23.3 21.4 21.3 21.8Births)Number of Maternal Deaths 16 50 82 114Maternal Mortality Rate (@ 1000 0.08 0.27 0.44 0.63Births) 33
  34. 34. Data of the ESIS Hospitals in Mumbai Name of Hospital No. of No. of patients treated No. of No. of beds 1980 doctors nurses Indoor Outdoor1.ESIS 550 12,000 15,500 64 161Hospital,Worli2.ESIS 650 18,000 40,000 80 193Hospital,Andheri3.ESIS 650 20,060 1,63,700 98 156Hospital,Mulund4.ESIS 300 1,800 2500 47 83Hospital,Kandivli 34
  35. 35. Data On The Working Of The ESIS Hospital, Mulund (W)A. Established in 1971B. No. of Wards – 20 (Ground + 5) o Ground floor – Supritendent Officer, ICCU & Casualty o 1st to 4th floor – 4 * 5 wards = 20 wards o 5th floor – Account office & ClubC. Kitchen – Ground floorD. OPD – Ground floorE. POD – Ground + 1F. Physiotherapy Building – Road Building groundG. World Band Building – Ground + 2H. Nurses Hostel – Ground + 2I. Medical Council – Ground + 2J. Store Building – GroundK. Dhobi Ghat – GroundL. School Building – GroundM. Mortuary – GroundN. Dustbin – Ground 35
  36. 36. Total Area Covered AreaType Building Levels Quarters Sq ftI 7 Ground + 3 7 x 4 x 12 = 336 172II 7 Ground + 3 7 x 4 x 4 = 112 375III 2 Ground + 3 2 x 4 x 4 = 32 6111IV 3 Ground + 3 3 x 4 x 2 = 24 940V 2 Ground + 3 2 x 4 x 2 = 16 1211VI 1 Ground + 3 1x4x2=8 1700Total Area 10,509 36
  37. 37. Staff Position Of ESI Hospital, Mulund Position of the post of the Staff Cadre Sanctioned post Filled VacantClass I 18 10 8Class II 33 28 6Class III 59 43 16Class IV 329 307 22Sister Incharge 20 9 11Staff Nurse 120 108 12Paramedical 42 37 5 37
  38. 38. Beds Distribution Of The ESIS Hospital, Mulund (W)Total Sanctioned Beds 400Medical 104Pediatrics 40General Surgery 96Orthopedic 38Obst & Gynaecology 72Ophtalmic 20ENT 20ICCU 5Casualty 5 38
  39. 39. Machines & Equipments in ESIS Hospital # Machines / Equipment Available Conditions Working Repairing Condemnation 1 300 MA XRay Unit 2 1 1 2 60 MA XRay Unit (Mobile) 2 2 3 Ultra Sound Unit 1 1 4 ECG Machine 6 3 1 2 5 SWD Mec 500W 1 1 6 SWD Mec 250W 1 1 7 Opg Microscope 1 1 8 Binocular Microscope 6 4 1 1 9 Blood Gas Analyzer 1 1 10 Histopathology Proc Unit 1 1 11 Erabuchem-5 1 1 12 ERMA-7 1 1 13 VDRL Rotator 1 1 14 Pulse Oximeter 1 1 15 Boyler Apparatus 5 5 16 Bowls Sterlizer 6 2 4 17 HP Sterlizer 2 1 1 18 CST Monitor 4 4 19 Renda Micro Motor 1 1 20 Baby Care Incubator 3 3 21 Photo Theraphy Unit 1 1 22 Refrigerator 8 8 23 Air Conditioner 15 13 2 24 Zerox machine 2 2 25 Fax Machine 2 1 1 26 Water Cooler 4 3 1 27 Ambulance 2 2* * 1 at Ulhasnagar 39
  40. 40. Statement Showing OPD Attendance Of ESI Hospital, MulundDEPARTMENTS 2005-06 2006-07 2007-08Medical 19,926 18,946 20,151Surgery 7,733 9,144 8,789Gynaecology 9,902 9,132 7,458Orthopeadic 10,843 14,069 17,743Peadiatric 3,065 2,850 2,063Ophthalmic 4,005 3,812 3,527ENT 3,250 3,549 3,262Skin 5,146 5,194 2,252ICCU 4,591 4,371 1,839TB 6,865 5,727 5,356 40
  41. 41. Statement Showing OPD Attendance Of ESI Hospital, Mulund Outbound Service Accident Total Per day2005-06 82016 21046 13526 116588 3922006-07 78793 18432 11375 108600 3622007-08 73714 17576 12842 104132 347Statement Showing Operations at ESI Hospital, Mulund Years Major Minor Pediatric 2005-06 872 2,563 12 2006-07 878 2,883 13 2007-08 693 2,960 12 41
  42. 42. In-Patient Department Record In the Speciality Of ESI Hospital, Mulund Years Medical Surgery Gynaec Pediatric 2005-06 3013 1496 1679 698 2006-07 3801 1640 1414 729 2007-08 3245 1455 1000 475 Years Ortho ENT Opth 2005-06 983 246 245 2006-07 272 237 199 2007-08 1111 200 175 Years NB TB ICCU 2005-06 712 2 299 2006-07 386 4 140 2007-08 380 3 46 42
  43. 43. Budget & Expenditure Of ESI Hospital, Mulund TOTAL APRIL MAY OBJECT DDO Budget Expenditure Budget Expenditure Budget Expenditure ADM.OFFR, E.S.I.S.01-SALARIES HOSPITAL.MULUND 12316 16430.449 6626 16430.449 6626 0 ADM.OFFR, E.S.I.S HOSPITAL WORLI03-OVERTIME ALLOWANCES NAKA, MUMBAI 1 16430.449 1 0 0 006-TELEPHONE ELECTRICITY AND ADM.OFFR, E.S.I.S.WATER CHARGES HOSPITAL.MULUND 1086 16476.223 150 34.449 150 11.325 ADM.OFFR, E.S.I.S.11-DOMESTIC TRAVEL EXPENSES HOSPITAL.MULUND 18 16476.223 4 0 4 0 ADM.OFFR, E.S.I.S.13-OFFICE EXPENSES HOSPITAL.MULUND 448 16778.392 509 6.314 509 295.855 ADM.OFFR,E.S.I.S.H OSPITAL.AUNDH14-RENT ,RATE AND TAXES CAMP 144 16778.392 0 0 5 0 ADM.OFFR, E.S.I.S.17-COMPUTER EXPENSES HOSPITAL.MULUND 14 16778.392 3 0 1 0 ADM.OFFR, E.S.I.S.19-DIET CHARGES HOSPITAL.MULUND 222 16778.392 184 0 184 0 ADM.OFFR, E.S.I.S.21-SUPPLIES AND MATERIALS HOSPITAL.MULUND 3492 17326.584 1730 0 1730 548.192 43
  44. 44. Resident Quarters Position of ESI Hospital, Mulund Type Total Filled Vacant I 336 268 68 II 112 65 47 III 32 20 12 IV 24 13 11 V 16 15 1 VI 8 8 0 44
  45. 45. Statement Showing Food Supply at ESI Hospital, Mulund  No. Of Patients – 172 as on 18/5/2009  Root vegetable – 14 kg  Leafy vegetable – 16-17 kg  Other vegetables – 23 kg  3 chapati / 1 katori rice / dal / leafy vegetable / root  Non-veg – 1 egg  Fruits – 1 sweet lime or banana  No Cold storage or modern facilities  Pressure cookers are ages old and out  Kneading was done on the black granite platform  No hygiene  Evening meals were prepared and kept around 2 noon - Cold food • To reduce cost – chicken stopped  1 egg instead of 2 eggs 45
  46. 46. From the KitchenDiet chart of ESI Hospital, Mulund 46
  47. 47. Food served at ESI Hospital, Mulund 47
  48. 48. Greivances of Patients at ESIS Hospital, Mulund The number of procedures involved before you can get medical aid is very daunting The quality of food is dismal Frequent unavailability of drugs and the basic medical tests makes it difficult for people from lower economic section, since they have to then avail private services and drugs at higher prices outside There needs to be stricter laws and policies for procurement of drugs and equipment at hospitals to curb corruption and spurious material There needs to stricter laws to stop quacks Transparency in the health insurance sector should be encouraged. Often people do not understand the procedures, hidden expenses etc Children should be provided with more nutritious food at more subsidized rates. Surgery costs are difficult for the poorer sections. Some kinds of Initiatives should be offered There are very few specialists in the hospitals. Also, there is a shortage of nurses The food in hospitals is often not edible. Milk provided is diluted horribly The management of medical waste is a serious concern Better staff to handle the medical machinery and equipment TB injections are expensive and often not available for free Basic drugs are to be bought from external chemist, the hospital chemist does not stock them, so patients have to pay for these drugs Sudden deliveries and pregnancy complication cases are denied admission leaving the poor hapless Basic first aid is often not available Pest control chemicals are diluted before spraying leading to ineffective pest control in slum areas Stay dogs and dog bites are a problem and needs to be reviewed rather than generate a govt v/s activist problem Rat and rodent infestation is a problem Hospitals in Mumbai are not very well equipped, especially in case of cancer treatment. Not all hospitals have the required technical support. Tata hospital is the only one that has it but it is insufficient and difficult to cater to so many patients at a time. And many people lose lives because of not being treated on time. Procedures/forms/registration are excessively lengthy and time consuming 48
  49. 49. Our Recommendations to the above problems Medicines banned abroad are sold in India. The policies regarding dumping of drugs by developed countries to India needs to be strictly looked at The issue of quacks which especially affects poor people should be looked at very seriously The matter of health insurance, criteria and transparency in this area along with stringent rules by the government is essential. Transparency regarding medical insurance, rules, registration, limitation need to be clearly explained and publicized Labour laws should be stringent about the company caring for the health of the employees Strict labour laws are needed for the number of working hours The cost of drugs and manipulating the MRP of drugs or selling over MRPs should be cracked down on Procedure for possession of the body from the morgue is delayed, leading to frustration in members Stricter implementation should be brought in place for sale of cigarette and gutka near institutions Mediclaim results in unreasonable escalation of costs because it is felt that the patient is just going to be reimbursed for all expensesSpecial Initiatives Health incentives to be given to girl’s parents. Government should encourage yoga facilities in hospitals School based health camps for public and private should be made compulsory Free health camps at public places in public private partnerships will be very helpful Health and counseling cells in educational institutions will be very beneficial There is still very little done to encourage research in the medical field and alternative means of medical treatment and practice People should be made aware of free TB treatment Conduct seminars on sex and sexuality education Encourage blood donation camps and also body / organ donation after death 49
  50. 50. Present Initiatives in working of ESICThe profiles of the Employees’ State Insurance Corporation are being changed towardsgreater accessibility and client satisfaction.The Employees State Insurance Scheme provides need based social security benefits toinsured workers in the organized sector. ESIC has taken up the daunting task of tailoringdifferent benefit schemes for the needs of different worker groups. The scheme, whichwas first introduced at two centers in 1952 with an initial coverage of 1.20 lakh workers,today covers 71.59 lakh workers in about 678 centers in the country. It benefits about310. 54 lakh beneficiaries including the family workers of the insured persons, across thecountry. The scheme is being gradually to cover new centers and steps are being takenfor creation of requisite infrastructure for providing medical care to a larger number ofinsured persons and their families. While the cash benefits under the scheme areadministered through a network of about 850 local offices and pay offices, medical careis provided through 141 ESI Hospitals, 43 ESI Annexes, 1451 ESI Dispensaries and 2789Clinics of Insurance Medical Practitioners. The total number of medical officers underthe Scheme is about 10,480.There have been a number of new developments in the ESIS during the past five years.Each year, it is extended to new areas to cover additional employees. The newemployees covered varied from 30,500 in 1998, 89030 in 2000 to 46430 till Jan., 2003.Low paid workers in receipt of daily wages up to Rs. 40/- have been exempted frompayment of their share of contribution. Earlier this limit was Rs. 25/-. This measure hasbenefited about six lakh insured workers across the country. In order to provide relief toinsured persons suffering from chronic and long term diseases, the list of diseases forwhich Sickness Benefit is available for an extended period up to two years at anenhanced rate of 70% of daily wages, was enlarged by adding four new diseases, keepingin view the international classification of disease profiles and the quantum ofmalignancies of some diseases which had come to light over the last few years. Thecontributory conditions for this benefit were also reduced from 183 days to 156 days inthe two-year period preceding the diagnosis.The ESIC has made plans to commission Model hospitals in each State. Thirteen States/UTs have so far agreed, in principle, to hand over one hospital each to the ESIC forsetting up of Model hospital. Two Hospitals have been earmarked for being developed forsuperspeciality medical care in cardiology, i.e., Rohini at Delhi and Chinchwad inMaharashtra.In order to improve the standard of medical care in the States, the amount reimbursableto the State Governments for running the medical care scheme has been increased to87.5 % of Rs. 700 per capita with effect from 1.4.2003. The ESIC has formulated actionplans for improving medical services under the ESI scheme with focus on modernizationof hospitals by upgrading their emergency and diagnostic facilities, development ofdepartments as per disease profiles, waste management, provision of intensive careservices, revamping of grievance handling services, continuing education programme,computerization and upgradation of laboratories etc. The action plans have been inoperation since 1998. The ESIC has also taken certain new initiatives to promote andpopularize Indian Systems of Medicines (ISM) along with Yoga and have drawn up 50
  51. 51. programmes for establishing these facilities in ESI hospitals and dispensaries in a phasedmanner.Social security to the workers in the organized sectorSocial Security to the workers in the Organized Sector is provided through five CentralActs, namely, the ESI Act, the EPF & MP Act, the Workmens’ Compensation Act, theMaternity Benefit Act, and the Payment of Gratuity Act. In addition, there are a largenumber of welfare funds for certain specified segments of workers such as beediworkers, cine workers, construction workers etc. 51
  52. 52. Overview Of Healthcare Services In IndiaHealthcare ServicesPublic institutions played a dominant role in the Indian Healthcare sector in the past, inthe urban as well as in the rural areas. However, the public healthcare has been on aserious decline during the last two or three decades because of non-availability ofmedical and paramedical staff, diagnostic services and medicines. Consequently therehas been a pronounced decline in the percentage of cases of hospitalized treatment inGovernment hospitals and a corresponding increase in the percentage treated in privatehospitals, despite higher costs in the private sector.The Group is of the view that it is imperative for the health and safety of the populationto enforce minimum standards on clinical establishments in both the private and publicsectors by laying down minimum standards and enforcing them rigorously. The ClinicalEstablishments (Registration and Regulation) Bill, 2007 having been introduced in theParliament it would important to ensure that it becomes law at the earliest and that itenters into force for all the States. The next step would be for the proposed NationalCommittee to set appropriate standards for all categories of clinical establishments.Implementation of the minimum standards will only be the initial step for improving thequality of healthcare institutions in the country. The next step for improving their qualityshould be for all stakeholders to advocate that these institutions take advantage of theaccreditation system already established in the country. It would be important for theCentral and State Governments to take steps to enable the clinical establishments in thepublic sector also to avail of the accreditation system.National Commission for Enterprises in the Unorganised Sector (NCEUS) proposed healthinsurance scheme for BPL families to cover the entire BPL population of 30 crore (5 crorefamilies) in five years time. The High Level Group recommended that the HealthInsurance Programme for BPL categories be implemented at the earliest.The overriding requirement in the country is for increasing the supply of human resourcesat all levels, from specialists to paramedical personnel and to improve their quality. TheGroup is of the view that the only way to accomplish this is for the medical educationsector to be opened up completely for private sector participation and companies to beallowed to establish medical and dental colleges just as they have been allowed to opennursing colleges. Other entry barriers such as the requirement of land and built up spaceneed also to be lowered to realistic levels in order to facilitate the opening up of newcolleges. Government’s role should be limited to opening a few high quality institutionsdedicated to research.In order to improve the quality of education in Government medical colleges it isnecessary to give incentive to the teaching faculty. Wherever possible they should beallowed to undertake private practice and in other cases granted handsome non-practicing allowance. 52
  53. 53. The establishment of the regulatory Paramedical Council is crucial for expansion oftraining facilities and for improvement of the training programme in respect ofparamedical personnel and the High Level Group expressed the hope that the law will beenacted shortly. In addition Government should encourage private players, includinglarge hospitals and hospital chains, to undertake training programmes under theregulatory control of the Paramedics Council. A development council for taking widerinitiatives for the training of paramedical personnel could also be considered.The High Level Group is of the view that the qualifications of doctors and radiologistswho have been trained in the UK or other foreign countries should be recognized by theIndian Medical Council on an exceptional basis in order to increase the pool of qualitymedical personnel available to the Indian service providers and increase theircompetitiveness in providing service for medical value travel, telemedicine as well asclinical research.The Group considers the shortage of trained personnel to be the biggest challenge forimproving the country’s competitiveness in the field of clinical research. The Grouprecommends the establishment of a Clinical and Medical Research Council with theparticipation of the private sector for formulating, promoting and running trainingprogrammes for the area.The Drugs Controllers office needs to be suitably strengthened and manned withpersonnel (including guest personnel from abroad) who are equipped with knowledge ofthe latest advances in medical research. A world class testing laboratory should be set upin the country in the PPP mode, where the Central Governments gives assistance forconstruction of building and purchase of equipment but the management is undertakenby the private sector. Arrangement needs to be made for accreditation of CROs for thepurpose of certifying their adherence to Guidelines for Good Clinical Practices. 53
  54. 54. In the past five decades life expectancy has increased from 50 years to over 64 in 2000.IMR has come down from 146 to 70. Crude birth rates have dropped to 26.1 and deathrates to 8.7. One of the recent projections made on the basis of Population Foundation ofIndia data is given below in table 2 indicating key demographic changes till 2021. Thedisparities among states are clear from table 2. Table.2: Demographic Projections: India & Major States 2001-2021: India / States Life Expectancies Crude Birth Rate Crude Death Rate M/F 2001 2021 2001 2021 2001 2021 68.9/73.India 24.6 19.2 8.7 6.8 62.9/64.9 5Andhra Pradesh 19.4 14 7.6 7.4 63.8/66.7 69.6/73.4Karnataka 21.6 14.9 7.9 7.1 63.8/67.1 69.3/72.6Kerala 16.4 12.1 5.4 6.3 71.9/77.5 75.8/81.2 66.9/69.Maharashtra 21.2 14.5 6.9 6.6 2 72.5/74.9Tamil Nadu 16.4 12.7 7.3 7.9 65.5/68.4 70.6/75.5 70.9/71.Bihar 28.7 18.8 9.1 6.4 64.0/62.0 5Madhya Pradesh 28.7 21.4 11.7 8.3 57.9/57.8 65.7/65.8Orissa 23.2 15 10.5 8.3 59.8/59.4 67.2/67.4 69.9/72.Rajasthan 29 24.9 9.1 6.3 62.3/63.4 6Uttar Pradesh 31.7 28.4 10.9 7 61.3/60.0 69.3/69.8At this stage, a process understanding of longevity and child health may be useful forunderstanding progress in future. Longevity, always a key national goal, is not merely thereduction of deaths as a result of better medical and rehabilitative care at old age. Infact without reasonable quality of life in the extended years marked by self-confidenceand absence of undue dependency longevity may mean only a display of technical skills.Such quality of life requires as much external bio-medical interventions as culture basedacceptance of inevitable decline in faculties without officious prolongation of life.Indeed, it must be realized that the pathways to longevity do not start at sixty but runacross life lived at all ages in reduction of mortality among infants through immunizationand nutrition interventions and reduction of mortality among young and middle agedadults, including adolescents getting informed about sexuality reproduction and safemotherhood. At the same time, some segments will remain always more vulnerable– such as women (due to patriarchy and traditions of intra-family denial), aged (whosepercentage will increase dramatically with improved health care), children (whosesurvival but not always development will increase with immunization) and the disabled(constituting a tenth of the population).Reduction in child mortality involves as much attention to protecting children frominfection as in ensuring nutrition and calls for a holistic view of mother and child healthservices. The cluster of services consisting of antenatal services, delivery care and postpartum attention and low birth weight, childhood diarrhea and ARI management arelinked priorities. Programs of immunization and childhood nutrition seen in better 54

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