1. SOCIAL AND MEDICAL INSURANCE OF
CITIZENS :-
BY – KAMAL SAINI
SOCIAL HEALTH INSURANCE IS USUALLY A HEALTH INSURANCE
SCHEME WITH SPECIFIC CHARACTERISTICS: TARGETS THE
FORMAL SECTOR .
IS FUNDED BY A COMPULSORY PAY ROLL TAX•
THE PREMIUM IS USUALLY INCOME RATED, I.E. THE LOWER
EMPLOYEES CONTRIBUTE A SMALLER PREMIUM COMPARED TO
THE HIGHER EMPLOYEES.
2. INTERNATIONAL EXPERIENCE ;-
The classical example of a SHI is the German or
Belgian health insurance system. Here, employees
and employers contribute to a “mutual fund(s)” that
is then used to finance the health care for the entire
population. Citizens have to enroll compulsorily in
one of these mutual funds. The government also
provides significant funding to cover those who are
not able to contribute.
3. Recently, Vietnam, which is a low-income country,
has introduced SHI and successfully covered most
of its population. The same goes for the Philippines,
which has managed to cover more than 50% of its
population in a short time. Kenya and Tanzania are
also embarking on ambitious plans of SHI to cover
their population.
4. SOCIAL HEALTH INSURANCE IN INDIA
In India, there are three important
schemes, the ESIS, the CGHS and the
Railways Health Scheme.
5. EMPLOYEE STATE INSURANCE SCHEME (ESIS)
Established in 1948, the Employees State Insurance
Scheme (ESIS) is a social security system, which
provides both cash and medical benefits.
Eligibility: Lower paid workers of the formal sector,
especially industries. (only those workers with a
salary of less than Rs 10,000 per month can join the
ESIS)
6. PROBLEMS
Less than half the enrollees use the ESIS facilities
because of the low quality of care. This is further
compounded by the rude and impudent
behaviors of the ESIS staff, shortage of staff,
inadequate
drug and supplies and non-functional equipment.
7. Many of the staff are not aware of the benefits. The
employers also do not disseminate the information to
their staff. Further some employers manipulate records to
make the staff ineligible for the benefits. Also because of
the salary limits on eligibility, some staff keep shifting in
and out of the ESIS and they may not be aware of their
eligibility status.
