Established in 1954, the CGHS covers employees and retirees of the Central Established in 1954, the CGHS covers employees and retirees of the Central Government, and certain autonomous, semi autonomous and semi-government organizations. Government, and certain autonomous, semi autonomous and semi-government organizations. It also covers Members of Parliament, retired central government servants, widows receiving It also covers Members of Parliament, retired central government servants, widows receiving family pensions, accredited journalists and members of the general public in some specified family pensions, accredited journalists and members of the general public in some specified areas. The families of the employees are also covered under the scheme. Benefits under the areas. The families of the employees are also covered under the scheme. Benefits under the scheme include medical care at all levels and home visits/care as well as free medicines and scheme include medical care at all levels and home visits/care as well as free medicines and diagnostic services. These services are provided through public facilities (including CGHS- diagnostic services. These services are provided through public facilities (including CGHS- exclusive allopathic, ayurvedic, Homeopathic and unani dispensaries) with some specialized exclusive allopathic, ayurvedic, Homeopathic and unani dispensaries) with some specialized treatment (with reimbursement ceilings) being permissible at private facilities. Of the total treatment (with reimbursement ceilings) being permissible at private facilities. Of the total expenditure, about a third is spent on wages and salaries of the CGHS staff.
expenditure, about a third is spent on wages and salaries of the CGHS staff.
The scheme is on the cooperative efforts and contribution basis from the employees The scheme is on the cooperative efforts and contribution basis from the employees and employer for their mutual benefits. The services are given through a network of and employer for their mutual benefits. The services are given through a network of dispensaries, government hospitals, and identified private specialised hospitals in various dispensaries, government hospitals, and identified private specialised hospitals in various systems of medicine.
systems of medicine.
The CGHS provides services are: The CGHS provides services are:
Emergency treatment, Emergency treatment, Outdoor services, Outdoor services, Indoor services, Indoor services, Domiciliary visits, Domiciliary visits, Specialist’s consultation, Specialist’s consultation,
Antenatal, natal and postnatal services Antenatal, natal and postnatal services Family welfare services.
Family welfare services.
Supplies optical and dental aids at reasonable rates. Supplies optical and dental aids at reasonable rates. Laboratory and x-ray investigation
Laboratory and x-ray investigation
Paediatric services including immunization Paediatric services including immunization
The ESI and CGHS cover two large groups’ wage earners in the country. They are well The ESI and CGHS cover two large groups’ wage earners in the country. They are well-- organized health insurance schemes, and are providing reasonable medical care plus some organized health insurance schemes, and are providing reasonable medical care plus some essential preventive and promotive health services. Experience in other countries has shown essential preventive and promotive health services. Experience in other countries has shown that health insurance is logical step towards nationalization of health services.
that health insurance is logical step towards nationalization of health services.
OTHER AGENCIES: OTHER AGENCIES: Defence medical services: Defence medical services:
It is own organization for medical care defence pe
It is own organization for medical care defence personnel under the banner ―Armedrsonnel under the banner ―Armed Forces Medical Services‖. The services provided are integrated and comprehensive Forces Medical Services‖. The services provided are integrated and comprehensive
embracing preventive, promotive and curative services. embracing preventive, promotive and curative services.
Health care of Railway Employees: Health care of Railway Employees:
The Railway provides comprehensive health care services through the agency of The Railway provides comprehensive health care services through the agency of Railway Hospital, Health Unite and clinics. Environmental sanitation is taken care of by Railway Hospital, Health Unite and clinics. Environmental sanitation is taken care of by
Health Inspectors in big stations .A chief Health Inspector supervises the division’s work. Health Inspectors in big stations .A chief Health Inspector supervises the division’s work.
Health check up of employees is provided at the time of entry into service, and thereafter at Health check up of employees is provided at the time of entry into service, and thereafter at
Private agencies: Private agencies:
In a mixed economy such as India’s private practice of medicine provides a large In a mixed economy such as India’s private practice of medicine provides a large
share of the health services available. It is rapid expansion in the number of qualified share of the health services available. It is rapid expansion in the number of qualified allopathic physicians from about 50,000 at the time of independence to about 7.67 lakhs in allopathic physicians from about 50,000 at the time of independence to about 7.67 lakhs in 2005 and the doctor population ratio for the country as a whole is 1:1428.the private sector of 2005 and the doctor population ratio for the country as a whole is 1:1428.the private sector of the health care services is not organized. Some statutory bodies like the medical council of the health care services is not organized. Some statutory bodies like the medical council of India and the Indian medical Association regulate some of the functions and activities of the India and the Indian medical Association regulate some of the functions and activities of the large body of private registered medical practitioners.
large body of private registered medical practitioners.
4)
4) Community health insurance in India: (CHI)Community health insurance in India: (CHI)
CHI is seen as an innovative mechanism meant for financing health care expenditure of CHI is seen as an innovative mechanism meant for financing health care expenditure of the people.
the people.
Types of CHI: Types of CHI:
3.
3. Provider model:Provider model: NGOs act both as insurer and provider of health care services.NGOs act both as insurer and provider of health care services. 4.
4. Insurance model:Insurance model: NGOs is the insurer and care is purchased from a private provider.NGOs is the insurer and care is purchased from a private provider. 5.
5. Intermediary model:Intermediary model: NGOs is neither the insurer nor care provider. It acts as anNGOs is neither the insurer nor care provider. It acts as an intermediary between the target population and the insurance provider.
intermediary between the target population and the insurance provider.
Rashtriya Swasthya Bima Yojana: (RSBY) Rashtriya Swasthya Bima Yojana: (RSBY)
It is the 3
It is the 3rdrd health insurance scheme from the Govt of India. The earlier ones arehealth insurance scheme from the Govt of India. The earlier ones are – –
Universal health Insurance Scheme and the NRHM. The RSBY is supposed to become Universal health Insurance Scheme and the NRHM. The RSBY is supposed to become operational from 2008-2009 and all 600 districts of the country to be covered by 2012.
operational from 2008-2009 and all 600 districts of the country to be covered by 2012.
Objective:
Objective: To provide health security for the Below Poverty Line (BPL) workers in theTo provide health security for the Below Poverty Line (BPL) workers in the unorganized sector and their families through an insurance that cover for hospital expenses. unorganized sector and their families through an insurance that cover for hospital expenses.
Provider:
Provider: public and private sector.public and private sector.
Claims and Reimbursement:
Claims and Reimbursement: through smart cardsthrough smart cards
Maximum Benefits:
Maximum Benefits: Rs. 30,000 per familyRs. 30,000 per family
Transportation cost:
Transportation cost: Rs. 100/trip/hospitalization.Rs. 100/trip/hospitalization.
Post hospital transportation expenses (5 days):
Post hospital transportation expenses (5 days): Rs. 1000 minimumRs. 1000 minimum
Implementing agency:
Implementing agency: An insurance company.An insurance company.
Community:
Community:All BPL families both rural and urban.All BPL families both rural and urban.
Premium:
Premium: 75% of the premium for the basic package will be paid by the Government of 75% of the premium for the basic package will be paid by the Government of India and 25% by the State government.
India and 25% by the State government.
Implementation of the scheme:
CONCLUSION: CONCLUSION:
Although insurance companies originally focused on paying for health care, they now Although insurance companies originally focused on paying for health care, they now are involved in establishing standards for care, evaluating care, and negotiating charges. are involved in establishing standards for care, evaluating care, and negotiating charges. They are active participants in all areas of health care and, because of the economic power They are active participants in all areas of health care and, because of the economic power they wield,have great influence. Insurance companies determine whom they will pay and they wield,have great influence. Insurance companies determine whom they will pay and what procedures they will reimburse. Thus, insurance companies can and do limit health care what procedures they will reimburse. Thus, insurance companies can and do limit health care choices.
choices.
BIBLIOGRAPHY: BIBLIOGRAPHY:
1)
1) Harish Basavaih ―Nursing Health Economics‖, 1Harish Basavaih ―Nursing Health Economics‖, 1stst edition 2009, Jaypee Publications.edition 2009, Jaypee Publications. Pp. 20-28, 64-72.
Pp. 20-28, 64-72. 2)
2) Park.K, ―Preventive And Social Medicine‖, 19Park.K, ―Preventive And Social Medicine‖, 19thth edition, Banarsidas Bhanot Publishers,edition, Banarsidas Bhanot Publishers, Jabalpur. Pp: 758
Jabalpur. Pp: 758 3)
3) Definition of health economics. Peter’s busiDefinition of health economics. Peter’s business and economic issues.ness and economic issues. 4)
4) BNS Rao, ―Sociology for Nurses‖, 6BNS Rao, ―Sociology for Nurses‖, 6thth edition, 2004, Gajana Publishers, pp.171-176.edition, 2004, Gajana Publishers, pp.171-176. 5)
5) Mosby's Medical Dictionary, 8th edition. © 2009, Elsevier.Mosby's Medical Dictionary, 8th edition. © 2009, Elsevier. 6)
6) http. // Wikipedia. Health economics.http. // Wikipedia. Health economics. 7)
7) Kightlinger, R. (1999). Sloppy records: The kiss of death for a malpractice defense.Kightlinger, R. (1999). Sloppy records: The kiss of death for a malpractice defense. Medical Economics 76(8): 109
Medical Economics 76(8): 109 – – 113.113. 8)
8) Porter-Porter-O’Grady, T. (1987). Shared governance and new organizational models. NursingO’Grady, T. (1987). Shared governance and new organizational models. Nursing
Economics 5(6):281
Economics 5(6):281 – – 286.286. 9)
9) Department of Health and Human Services (DHHS), Health Insurance and PortabilityDepartment of Health and Human Services (DHHS), Health Insurance and Portability Act, Available at http://cms.hhs.gov/hipaa/. Accessed August 4, 2002.
Act, Available at http://cms.hhs.gov/hipaa/. Accessed August 4, 2002. 10)
10)Janice Rider Ellis, Celia Love Hartley, ―Nursing in Today’s World‖, 8Janice Rider Ellis, Celia Love Hartley, ―Nursing in Today’s World‖, 8ththedition, pp. 48-edition, pp. 48- 53, 111-120, 140-143.
53, 111-120, 140-143. 11)
11) Nahomi Clement, Nahomi Clement, Community Community Based Based Health Health Insurance, Insurance, ―Nightingale ―Nightingale Nursing Nursing Times‖;Times‖;
5(5):28-29:2009. 5(5):28-29:2009.