Download - Health scheme
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HEALTH SCHEME
BYAMBILY ULAHANNAN
FINAL YEAR MSC NURSINGP.D HINDUJA COLLEGE OF NURSING
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GENERAL OBJECTIVESAt the end of the session the student
gain knowledge about health schemes of the country and apply that in the field of community health nursing
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SPECIFIC OBJECTIVESAt the end of the session the group will be
able to • Define the health scheme in India• List down the need of health insurance• Explain the purpose of heal insurance• Discuss the type of health schemes in India• Explain the role of nurse in health scheme.
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DEFINITION Health insurance programme, people
who have the risk of a certain event contribute a small amount (premium) towards a health insurance fund. This fund is then used to treat patients who experience that particular event (e.g. hospitalization
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OBJECTIVES Health insurance programme have
two main objectives:• To increase the access to health care• To protect the employees from high
medical expenses at the time of illness.
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HEALTH SCHEME IN INDIAIT IS MAINLY CLASSIED INTO FOUR• Mandatory Health Insurance schemes The two mandatory government run schemes
includes:Central Government Health Schemes(CGHS)Employee’s state insurance scheme(ESIS• Employer based scheme The railways ,defense and security forces provides
medical benefits to the employeesVoluntary Health Insurance Schemes Or Private
For Profit Scheme
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MANDATORY SCHEME
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EMPLOYEES STATE INSURANCE SCHEME
• Started in the year 1948• programme provides health care to
industrial labors and their families • money is contributed by the
management as well as the employees.
• It extends the whole India
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BENEFICIARIES• Non –power using factories employing ten or
more persons.• Power using factories employing ten or more
persons• Road transport establishments• Cinemas and theaters• Hotels and restaurants• shops
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BENEFITMEDICAL
SICKNESS
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MATERNAL
DIASBLEMENT
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dependent
FUNERAL
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REHABILITAION
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CONTRIBUTION• Employer - 4.75 percent of the total wages• Employee - 1.75 percent of his /her wage• Sate government - 1/8 th of the total
expenditure of medical care.• ESI co operation - 7/8 th of the total
expenditure of medical care• As far the central government is concerned
it supports 2/3 of the administrative expenditure.
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LIMITAIONS
• Less than half the enrollees use the ESIS facilities because of the low quality of care
• Many of the staff are not aware of the benefits.
• The employers also do not disseminate the information to their staff.
• There is duality of control, with both the ESIC and the State governments trying to establish superiority
• Poor penetration in rural areas
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• Act does not include employees of Indian navy, military or air force; or whose wages exceed Rs. 15000 or as prescribed by the Central Government
• To avail of the sickness benefit, the employee has to have worked for 78 days prior to the sickness. Similarly, to avail of the maternity benefit, the woman has to have worked for 70 days prior to the sickness.
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CENTRAL GOVERNMENT HEALTH SCHEME
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INTRODUCTION• For the central government
employers • It was introduced in Delhi in 1954AIM• to provide comprehensive health
care to the employees
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OBJECTIVES• To give extensive medical facilities
too central government employees and their family members
• To save the government from heavy expenses on medical refund.
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BENIFICERIES• Central government employees and their
family members• Members of parliament• Judge of supreme court and high court• Freedom fighters• Pensioners of central government semi
government organizations• Journalists• Governors and ex- Vice presidents
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FACILITIES• Outdoor treatment facilities in all medical systems• Emergency services in allopathy system• Free medication• Facilities for laboratory tests and radiological tests• Treatment facilities for serious patients at their
home• Specialist consultation facilities• Treatment facilities in the government or
government recognized private institutes.• Facilities for 90 percent advanced payment, in
case of need.
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PROBLEMS
EQUITYDEMAND
SIDE MORAL HAZARD
POOR QUALITY
CARE
HIGH OUT OF POCKET
EXPENDITURE
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EMPLOYEE BASED SCHEME
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DEFENSE SCHEME
RAILWAY SCHEME
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PRIVATE AGENCIES
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MEDICLAIM THIRD PARTY ADMINISTRATOR
INSURANCE REGULATORY
DEVELOPMENT AUTHORITY
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Role of nurse
EDUCATOR COLLABORATER
ADVOCATE CASE FINDER
COUNSELOR
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THANK YOU