“What makes for a good healthcare system is universal and adequate access without excessive burden. There is one possible solution for providing such coverage”.
Please read the following suggestion and decide whether it is worth considering.
Following is a humble attempt to suggest a scheme whereby every single citizen of our great country gets the coverage of health-CUM-death insurance, with least hassles.
Some Basic Assumptions
a) Any major scheme such as “Universal access to healthcare” should necessarily be a joint venture of public-private participation.
b) The implementing agencies would be responsible to the governments for the successful execution of the programme.
c) Even the most illiterate/ignorant citizen should be able to avail of the health/insurance scheme easily. All that one has to do is to flash his/her Identification Card in any of the recognized hospitals/institutions/authorized medical attendants of ones choice in any part of the country to avail of the benefit. The citizen would not be required to pay single paise to any one for the medical services.
d) In case of any grievance watch dog personnel with adequate powers should be available at hand that would come to the spot and resolve the problems/inadequacies, if any.
e) Also visitors to this country should be able to avail of medical facilities against a prescribed fee on arrival. This will be in keeping with our motto अतिथि देवो भव.
We have attempted to make suggestion as simple as possible. No doubt it would need further improvements at the hands of experts.
Without going into the inadequacies and inequalities of the existing Social Security Legislations, a highly simplified Social Security Scheme is being suggested which would cover each and every citizen of this country. As reported in a Mumbai Based prominent Newspaper one of the CEOs of a prominent Insurance Company had said, “It would be impossible to give insurance coverage beyond the age of 75”. In the proposed legislation it would be possible to give insurance coverage even to centurions.
Indian population is around 121 crores. Assuming that we need an annual premium of Rs.2000 per citizen, we would need Rs.2.04 lakh crores per annum. We may err on the safer side and assume the fund requirement as Rs.4 lakh crores per annum.
Since we have the advantage of the numbers it is assumed a premium of Rs.2000 per head per annum should be adequate to meet the cost of treatment-cum-insurance.
How to raise Fund
As per Pune based Arthakranti organization, the annual withdrawal by way of cheques and other bank instruments is around 800 lakh crores. We withdraw money to get/avail of goods and services as CONSUMERS.
As CONSUMERS it is our sacred duty to contribute towards the welfare of the Society (service/goods provider).
If just 50 naye paise are levied as TDS against withdrawal, it would give a net yield of Rs.4 lakh crores every year without any paper work. If you take into account the cash/ATM i.e. non-bank instrument transactions the amount of 800 lakh crores referred to above would swell manifold. A TDS of 1% would give an yield of 8 lakh crores per annum. I am leaving it to the discerning people to work out actual fund requirement for HEALTH CARE (Medical treatment, Insurance, health measures like preventive steps etc.) and arrive at fund requirement and appropriate TDS to be levied against WITHDRAWALS from the Banks.
Scheme in brief
a) An authority would be established known as “Samaaj Suraksha Adhikaran/Social Security Authority” – SSA for short.
b) SSA would recognize periodically series of Hospitals like Government/Cantonment/Municipal Hospitals/ESI/Government Employees Health Schemes and private hospitals like Bombay Hospital, Apollo Hospitals, Jaslok, and similar institutions for medical treatment/hospitalization.
c) Uniform realistic rates would be prescribed by him for the various services like x-rays/MRI/Scan/Hospitalization etc. for the entire country.
d) Beneficiaries needing the services would present themselves before the recognized Hospital of one’s choice for treatment. Aadhaar card/Driving Licence/Voter ED etc would serve as the ID.
e) The beneficiary is treated as a paying-patient but would not be required to pay single paise for one’s treatment. All the costs would be borne initially by the Hospitals themselves, who would periodically claim reimbursement from the SSA. As paying patients they would be entitled as a (decent) Ward. Those desirous of very high Specialized treatment should be required to pay charges from their own pockets.
f) In the case of disablement/death a very liberal compensation/pension can be given to the victims or nominees.
g) Similarly Authorized Medical Attendants (AMA) would be recognized, rates for various services would have been prescribed by SSA. They would not charge the patients. They would also get reimbursement from SSA periodically.
h) For supply of medicines prescribed by the AMAs Chemists/Druggists/Pharmacy would similarly be recognized by the SSA – who in turn will get reimbursement from SSA against medicine supplied.
i) Watch dogs to be appointed at different strategic locations, who would keep a watch by visits to Hospitals etc. so that possible misuse of the Scheme is kept to the minimum. Also they should be available on call 24×7 to the citizens so that they can come personally to the spot and remedy the situation when contacted by the concerned citizen (beneficiary) by phone/mobile/in person.
j) Thus all the citizens would be entitled to benefits as befitting a contributor. Those who want specialized treatment in extra Special Ward etc may be charged the different.
k) There should be a feedback system so that the SSA receives information about the quality of services rendered by the Institutions and AMAs.
ANY SCHEME HOWEVER METICULOUSLY DRAWN IS BOUND TO BE MISUSED BY A MICROSCOPIC PERCENTAGE OF BENEFICIARIES. APPREHENSION OF MISUSE SHOULD NOT BE A GROUND FOR OUTRIGHT REJECTION OF THE PROPOSAL! WHILE ALLOWING FOR THIS LEAKAGE, WE SHOULD TRY TO CURB THIS MENACE TO THE EXTENT POSSIBLE BY APPOINTING WATCHDOG TEAMS/FLYING SQUADS CONSISTING OF SOCIAL WORKERS ARMED WITH WIDE POWERS, SOME OF WHOM IN TURN CAN ALSO BE DISHONEST TO SOME EXTENT.
Let us not shelve this idea on the ground that the Scheme is likely to be misused. Even if there be say 10-15% misuse the remaining 85-90% would stand to gain immensely.
In order to reach the rural and neglected areas the SSA can think of giving incentives by way of reimbursement at somewhat higher areas. The doctors opting for posting at such places can also be given some meaningful attractive incentives. It will also be a good idea that SSA ascertains from the patients/beneficiaries the quality of services rendered by the recognized institutions/hospitals. The subject is so wide and complex that one can go on giving more and more suggestions – but it would still be inadequate. Let us embark on this Sacred Project. As we get going, we can further improve and fine tune the system.
These are details to be worked out in more precise terms.
It is only a cryptic suggestion for the consideration of well-wishers, social workers and legislators to consider the proposal and to come out with a viable but simplified legislation. Various checks and balances will also have to be formulated so that there is least fraud. But we should not shelve the project.
To sum up
1. We have a central authority in place known as Samaj Suraksha Authority.
2. Banks collect and place the amount of around Rs.4 lakh crores at the disposal of the SSA.
3. It is funded by the consumers. The more you consume, more you pay and less you consume, you pay less. However, the benefit is same and uniform for all.
4. SSA recognizes Hospitals/Institutions/AMAs/Chemists. They get reimbursement from SSA.
5. A common tariff laid for the entire country and reviewed periodically.
6. Citizens avail of these cashless services at the place of their choice.
7. Powerful Watchdogs/Flying Squads are there to oversee the function.
8. For Rural Areas special extra incentives are given so that greater numbers of institutions/hospitals/AMAs are encouraged to move to rural areas.
9. Foreign visitors can be extended this benefit against a Flat Premium payable on their arrival.
Lastly, once the Scheme is implemented, it is continuously monitored and improvements introduced from time to time.
Further course of action – Shri Nishikant Dubey’s suggestion of minimum pension of 5000 rupees can be taken care under the above scheme. Taking into consideration the cost of Healthcare, Insurance on the death/disability and a pension of around 5000 after retirement (60 years) and a suitable TDS deduction against BANK WITHDRAWALS which would not exceed 4-5% could be decided upon.
May our country prosper!!!
Let Almighty show us the best way!!!
By: S. Vishwanathan