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ESIS Hospital




                1
Acknowledgement..............................................................4
Objectives Of The Study:.....................................................5
Employee State Insurance Corporation....................................6
ESI Scheme.......................................................................8
  Corporation.................................................................................8
  Constitution of Corporation.............................................................9
  Statement...................................................................................9
Coverage 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?....................................................................31
Mumbai Facts and Figures..................................................33
Data of the ESIS Hospitals in Mumbai.....................................34
Data On The Working Of The ESIS Hospital, Mulund (W).............35
  Total Area Covered......................................................................36
  Staff Position Of ESI Hospital, Mulund ...............................................37


                                                                                                       2
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........................45
From the Kitchen.............................................................46
  Diet chart of ESI Hospital, Mulund...................................................46
Our Recommendations to the above problems........................49
Special Initiatives.............................................................49
Present Initiatives in working of ESIC....................................50
Overview Of Healthcare Services In India...............................52
  Healthcare Services.....................................................................52
  Public Health System....................................................................56
  Initiatives on Public Health Infrastructure in the XI Plan........................57
Challenges before the healthcare sector in India......................58
  Regulation.................................................................................58
  Licensing...................................................................................59
   ..............................................................................................60
Skill Deficit in Healthcare .................................................61
Indian Medical Professionals in Foreign Countries.....................62
  Health Education.........................................................................63
  Limited Coverage of Health Insurance...............................................64
Responding To Challenges..................................................65
  Regulation of clinical establishments and improving the quality of healthcare
  institutions................................................................................65
  Expanding Health Insurance ...........................................................65
  Medical Education .......................................................................66
Concern: .......................................................................68
Dead-end:......................................................................70
Report Of The National Commission On Macroeconomics And Health
....................................................................................71
Analysis of effects made for evolving standards and developing an
accreditation system.........................................................73
Ministry Level Infrastructure ..............................................76
Regional Level Infrastructure..............................................77
Regional Level Infrastructure..............................................78
ESI Hospitals In Mumbai......................................................79
ESI Branch Offices In Mumbai Region (Maharashtra)..................80
Member Of Employees's State Insurance Corporation................85
Photo Gallery .................................................................89



                                                                                                 3
Acknowledgement


At the outset, it is my duty to acknowledge         with `gratitude
the generous help that I received from all        the offices and
individuals towards completion of this project.    It was for their
proactive support that a survey work of this      magnitude could
be completed.

Special thanks to the entire ESIS team under the guidance of
Mr Acharya , AO and to Mr Gunje in particular. It was for their
unending support that the project team could finish its report on
time.

Our heartfelt appreciation also goes to Mr Jandhlekar, Kitchen In-
charge and Ms Mudras, Dietician providing timely information to the
project team.

Dr. W A Dalvi, RMO deserves special mention for the support received
from him




                                                                   4
Objectives Of The Study:


The Employees' State Insurance Corporation (ESIC) of India is one of
the largest social security organizations providing medical insurance
cover and delivering of medical care to 35 million beneficiaries
through 140 hospitals and 1500 dispensaries.

The objectives of this study are to understand the working system of
ESI hospital and suggest systems for e-governance to facilitate the
coordination 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 in
practice for offering medical benefits to the insured persons and their
beneficiaries. This working paper brings out our detailed analysis of
the working of ESI hospital, Mulund in delivering medical care under
the ESI scheme.




                                                                      5
Employee State Insurance Corporation

The Employees' State Insurance Act (ESI Act), promulgated by the Indian Parliament in
1948, provides a comprehensive social security for workers in the lower wage bracket.

The ESI Act applies to non-seasonal, power using factories or manufacturing units
employing ten or more persons and non-power using establishments employing twenty or
more 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 the
purview of the Act. Employees of the aforesaid categories of factories and
establishments, but drawing wages only up to Rs.6500/- a month, are entitled to health
insurance cover under the ESI Act. The wage ceiling for purpose of coverage is revised
from 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 industrial
units at Kanpur and Delhi. Over the last four and a half decades, ESIS has emerged as the
largest multidimensional social security set up in Southeast Asia. As of now, the ESI Act is
applicable to over 250,000 industrial units in the country, benefiting about 87 lakhs
family units of workers in the lower wage bracket, accounting for a total beneficiary
population of about 330 lakhs.

ESIS guarantees full medical facilities to the beneficiaries and adequate cash
compensation to insured persons. Medical benefit comprises outpatient care, domiciliary
visits, specialist and diagnostic services, hospitalization, super specialist treatment, free
supply of drugs, dressings, artificial aids and appliances, besides immunization and family
welfare service, etc. Cash benefits include benefits payable in cash on account of loss of
wages or earning capacity caused by sickness, temporary disablement, occupational
disease, maternity or death or permanent disablement of an insured person
due to employment injury or an occupational disease.

ESIS is a self-financing health insurance scheme. Contributions are raised from covered
employees and their employers as a fixed percentage of wages. Covered employees
contribute 1.75% of the wages, whereas, the employers contribute 4.75% of the wages of
the covered employees. Contributions are the same irrespective of the nature of
employment 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 by
employees and employers are deposited in a common pool known as the ESI Fund. ESI
fund is utilized for meeting the administrative expenses of the ESI scheme, as well as the
cash and medical benefits to the insured persons and their dependants ESIS is
administered by a corporate body called Employees' State Insurance Corporation (ESIC).
The Union Minister of Labour heads the corporation as its Chairman. Its members include
representatives from the employers, employees, the central and state governments,
medical professionals and members of the parliament. Certain important statistics of
ESIC are given in Exhibit 1. Revenue receipts and expenditure of ESIC for the year 1999-
2000 are given in Exhibit 2.




                                                                                           6
ESIC has set up a large number of hospitals, dispensaries, and diagnostic centres across
the country for delivering primary, outpatient, and inpatient healthcare services. ESIC is
one of the few organizations wherein the concept of 'a proper referral system' is adhered
to. Those seeking medical attention under the scheme are required to first consult their
doctor at the designated dispensaries. The doctors at the dispensaries would if required
refer the patients for indoor treatment. Patients, who are advised to undergo indoor
treatment, have the option to choose any ESI hospital or an ESI approved hospital
according to their preferences, except in the case of super specialty treatment which are
available under the scheme only at a few designated hospitals. Clinical investigation
services, outpatient and inpatient treatments, as well all the prescribed medicines and
drugs 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. The
expenditure incurred on provision of medical benefit is shared by the corporation and the
state governments in the ratio of 7:1 within the prescribed per capita ceiling on
expenditure. From 1-4-99, ESIC has fixed the ceiling of expenditure for medical facilities
per insured person family unit at Rs. 600.

This ceiling of Rs. 600 is further divided into the following four categories of
expenditure:

• A maximum of Rs. 170 per Insured Person (IP) family unit per annum for drugs and
dressings
• A maximum of Rs. 20 per IP family unit per annum for maintenance and repair of
medical equipments
• A maximum of Rs. 50 per IP family unit per annum for expenditure to be incurred
towards reimbursement of super specialty services not available in ESI institutions,
• A maximum of Rs. 360 per IP family unit per annum towards salaries and administrative
expenses.

Amount spent by a State Government (on medical benefits) beyond this per capita limit is
borne by the State Government itself. A comparison of medical benefits across all the
states and union territories is given in Exhibit 3.




                                                                                        7
ESI Scheme
Employees’ State Insurance Scheme of India is an integrated social security scheme
tailored to provide social protection to workers and their dependants, in the organised
sector, in contingencies, such as, sickness, maternity and death or disablement due to an
employment injury or occupational hazard.

The ESI Act, (1948) applies to following categories of factories and establishments in the
implemented 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 of
the ESI Act to various classes of establishments, industrial, commercial or agricultural or
otherwise. Under these enabling provisions most of the State Govts have extended the
ESI Act to certain specific class of establishments, such as, shops, hotels, restaurants,
cinemas, preview theatres, motors transport undertakings and newspaper establishments
etc., employing 20 or more persons. The ESI Scheme is mainly financed by contributions
raised from employees covered under the scheme and their employers, as a fixed
percentage of wages. Employees of covered units and establishments drawing wages upto
Rs.10,000/- per month come under the purview of the scheme for social security
benefits. However, employees’ earning upto Rs.50/- a day as wages are exempted from
payment of their part of contribution. The State Govts bear one-eighth share of
expenditure on Medical Benefit within the per capita ceiling of Rs.900/- per annum and
all additional expenditure beyond the ceiling.

Employees covered under the scheme are entitled to medical facilities for self and
dependants. They are also entitled to cash benefits in the event of specified
contingencies resulting in loss of wages or earning capacity. The insured women are
entitled to maternity benefit for confinement. Where death of an insured employee
occurs due to employment injury, the dependants are entitled to family pension



Corporation

The Employees’ State Insurance Scheme is administered by a corporate body called the
ESI Corporation.

The Corporation is the highest policy making and decision taking authority under the ESI
Act and oversees the functioning of the Scheme. The Corporation meets periodically to
conduct business as may be required to regulate the functioning of the Scheme.




                                                                                           8
Constitution of Corporation

This apex body is constituted and notified by the Central Government for a four year
term and represents various interest groups comprising employees, employers, the
Central and State Governments besides the parliament and medical profession. Union
Minister of Labour functions as the Chairman of the Corporation whereas, Director
General ESIC, is also an ex-officio member of the Corporation.


Statement

To provide for certain benefits to Employees in case of sickness, maternity and
employment injury and to make provisions for related matters.




                                                                                  9
Coverage Under The ESI Act, 1948
The Act was originally applicable to non-seasonal factories using power and employing 20
or more persons; but it is now applicable to non-seasonal power using factories
employing 10 or more persons and non-power using factories employing 20 or more
persons.

Under Section 1(5) of the Act, the Scheme has been extended to shops, hotels,
restaurants, cinemas including preview theatre, road motor transport undertakings and
newspaper establishment employing 20 or more persons.

The existing wage-limit for coverage under the Act, is Rs.10,000/- per month (with effect
from 1.10.2006).



Areas Covered

The ESI Scheme is being implemented area-wise by stages. The Scheme has already been
implemented in different areas in the following States/Union Territories



States


All the States except Nagaland, Manipur, Tripura, Sikkim, Arunachal Pradesh and
Mizoram.



Union Territories

Delhi, Chandigarh and Pondicherry



Coverage :

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
Finance


The Scheme is mainly financed by contributions from employers and employees. The
employers’ contribution is equal to four and three fourth per cent of the wages payable
to employees. The employees’ contribution is at the rate of one and three-fourth per
cent of the wages payable to an employee. The State Governments share expenditure on
the 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
Contribution


E.S.I. Scheme being contributory in nature, all the employees in the factories or
establishments 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 of
employer’s contribution and employee’s contribution at a specified rate. The rates are
revised from time to time. Currently, the employee’s contribution rate (w.e.f. 1.1.97) is
1.75% of the wages and that of employer’s is 4.75% of the wages paid/payable in respect
of the employees in every wage period. Employees in receipt of a daily average wage
upto Rs.50/- are exempted from payment of contribution. Employers will however
contribute their own share in respect of these employees.



Collection of Contribution

An employer is liable to pay his contribution in respect of every employee and deduct
employees contribution from wages bill and shall pay these contributions at the above
specified rates to the Corporation within 21 days of the last day of the Calendar month in
which the contributions fall due. The Corporation has authorized designated branches of
the State Bank of India and some other banks to receive the payments on its behalf.



Contribution Period and Benefit Period

There are two contribution periods each of six months duration and two corresponding
benefit periods also of six months duration as under.

Contribution period       Corresponding Cash Benefit period

1st 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
Benefits



The 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 Expenses

An interesting feature of the ESI Scheme is that the contributions are related to the
paying capacity as a fixed percentage of the workers wages, whereas, they are provided
social security benefits according to individual needs without distinction.

Cash Benefits are disbursed by the Corporation through its Local Offices LOs/ Mini Local
Offices (MLOs)/Sub Local Offices SLOs)/pay offices, subject to certain contributory
conditions.

In addition, the scheme also provides some other need based benefits to insured
workers.

These includes :

          i.   Rehabilitation allowance
         ii.   Vocational Rehabilitation
        iii.   Unemployment Allowance (Under Rajiv Gandhi Shramik Kalyan Yojana)




                                                                                     13
Type Of Medical Benefits Provided

The Employees’ State Insurance Scheme provides full medical care in the form of medical
attendance, treatment, drugs and injections, specialist consultation and hospitalization
to insured persons and also to members of their families where the facility for Specialist
consultation, hospitalization has been extended to the families.

For the families, this benefit has been divided into two categories as under:-

Full Medical Care

This consists of hospitalization facilities and includes specialist services, drugs and
dressings and diets as required for in-patients.

Expanded Medical Care

This consists of consultation with the specialists and supply of special medicines and
drugs as may be prescribed by them in addition to the out-patient care. This also
includes facilities for special laboratory tests and X-Ray examinations.

Apart from the curative services provided through hospitals and dispensaries, the
Corporation also provides the following facilities including family welfare services.

Immunization

The Corporation has embarked upon a massive programme of immunization of young
children of insured persons. Under this programme, preventive inoculation and vaccines
are given against diseases like diphtheria, pertusis, polio, tetanus, measles, mumps,
rubella, tuberculosis etc.

Family Welfare Services

Along with the immunization programme, the Corporation has been undertaking provision
of family Welfare Services to the beneficiaries of the Scheme. The Corporation has
organized these services in 180 centres besides reserving 330 beds in hospitals for
undertaking tubectomy operations. So far, 828976 sterilization operation viz. 176197
vasectomies and 652779 tubectomies have been performed upto 31.3.1999. The ESI
Corporation has also extended additional cash incentive to insured persons to promote
acceptance of sterilization method by providing sickness cash benefit equal to full wage
for a period of 7 days for vasectomy and 14 days for tubectomy. The period for which
cash benefit is admissible is extended beyond the above limits in the event of any
complications after Family Planning operations.




                                                                                       14
Supply Of Special Aids

Insured 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 Benefits

Sickness Benefit represents periodical cash payments made to an IP during the period of
certified sickness occurring in a benefit period when IP requires medical treatment and
attendance 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 daily
wages 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 less
than 78 days during the corresponding contribution period.

(ii)A person who has entered into insurable employment for the first time has to wait for
nearly 9 months before becoming eligible to sickness benefit, because his corresponding
benefit period starts only after that interval.

(iii)Sickness Benefit is not payable for the first two days of a spell of sickness except in
case of a spell commencing within 15 days of closure of earlier spell for which sickness
benefit was last paid. This period of 2 days is called "waiting period". This provision
should be clearly understood by IMOs/IMPs as actual experience shows that such of IPs
who want to avail medical leave on flimsy grounds generally come for First
Certificate/First & Final Certificate within 15 days of earlier spell, usually on unpaid
holidays and/or on each weekly off etc, to avoid loss of benefit for 2 days due to fresh
waiting period.

Sickness Benefits

Extended Sickness Benefit

Enhanced Sickness Benefit




                                                                                          15
Extended Sickness Benefit

IPs suffering from long term diseases were experiencing great hardship on expiry of 91
days 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 Sickness
Benefit)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 exhausting
Sickness Benefit to which he may be eligible. A common list of these long term diseases
for which ESB is payable, is reviewed by the Corporation from time to time. The list was
last reviewed on 5.12.99 and revised provisions of ESB became effective from 1.1.2000
and at present this list includes 34 diseases which are grouped in 11 groups as per
International Classification of diseases and theo names of many existing diseases have
been 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
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.   Dementia

XI Others

   32. More than 20% burns with infection/complication
   33. Chronic Renal Failure
   34. Reynaud’s disease/Burger’s disease.




                                                                                     17
1. In addition to the above list, Director General/Medical Commissioner are authorised to
sanction ESB for a maximum period upto 730 in cases of rare but treatable diseases or
under special circumstances, such as, adverse reaction to drugs which have not been
included in the above list, depending on the merits of each case, on the
recommendations of RDMC/AMO or either authorised officers runniong the medical
scheme.

2. To be entitled to the Extended Sickness Benefit an Insured Persons should have been in
continuous employment for 2 years or more at the beginning of a spell of sickness in
which 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 309
days in chronic suitable cases by Regional Dy. Medical Commissioner/Medical
Referee/Administrative Medical Officer/Chief Executive of the E.S.I. Scheme in the State
or his nominee on the report of the specialist(s).




Enhanced Sickness Benefits

It 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 enhanced
sickness benefit at double the rate of sickness benefit i.e., about full average daily wage
for undergoing sterilisation operations for family welfare. Duration of enhanced Sickness
Benefits is upto 7 days in the case of Vasectomy and upto 14 days in the case of the
Tubectomy from the date of operation or from the date of admission in the hospital as
the case may be. The period is extendable in case of post operative complications.




                                                                                        18
Maternity Benefits

Maternity Benefit is payable to an Insured Woman in the following cases subject to
contributory conditions:-

Confinement-payable for a period of 12 weeks (84 days) on production of Form 21 and
23.

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 not
exceeding 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 a
child, 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 the
average daily wage.




Temporary disablement Benefit (TDB)

(a) TDB is payable to an employee who suffers employment injury (EI) or Occupational
Disease and is certified to be temporarily incapable to work. "Employment Injury" has
been defined under Section 2(8) of the Act, as a personal injury to an employee caused
by 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 disease
is 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
(d) Duration of TDB :

There is no prescribed limit for the duration of TDB. This is payable as long as temporary
disablement lasts and significant improvement by treatment is possible. If a Temporary
Disablement spell lasts for less than 3 days (excluding day of accident), IP will be paid
sickness benefit, if otherwise eligible. A special point for IMOs/IMPs is that some IPs may
resist 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 read
with provision of 6(A) of Section 2 in cases where an IP dies as result of EI. The age of
dependants, has to be determined either by production of

Documentary evidence as specified in Regulation 80(2) or

Age 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 are
increased from time to time. The latest enhancement is with effect from 01.08.2002




System of Treatment

Generally, the allopathic system of medicine is used for providing Medical Benefit.
However, where a substantial number of workers demand treatment by Indian system of
medicine and Homoeopathy (ISM & H) other than Allopathy and where the State
Government has recognised the qualifications in such system, treatment facilities may be
provided under the ISM & H as well. The various ISM &H systems of treatment in vogue
are:, Ayurvedic, Unani, Sidha, Yoga therapy and Homeopathy.

Certificates required for the purpose of Cash Benefits in respect of persons treated by
ISM &H should be issued by IMO /IMP having recognised qualifications in such system and
duly appointed by the State Government. The issue of certificates under ISM &H is
possible only where dispensaries in systems other than allopathic medicine are
functioning independently with IPs and their family units attached to them and not
functioning merely as referral units. In places where ISM &H units function only as
referral centres, certificates will have to be issued by the Allopathic dispensary to which
the IP is attached.




                                                                                        20
Scale of Medical Benefit

The scale of Medical Benefit under section 57 of Act to be provided to the IPs and
members of their families is to be prescribed by State Government in consultation with
the Corporation under Section 58(1 & 3) of Act under State Medical Benefit Rules. An IP
and/or a member of his family does not have the right to claim Medical Services over and
above those which have been so prescribed. The beneficiaries are entitled to reasonable
medical, 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 members
in all implemented areas as the rates of the contribution paid by the employees and the
employers are the same throughout the country.




                                                                                         21
Benefits to Retired IPs



Medical 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 be
provided (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 State

The administration of Medical Benefit under the ESI Scheme is the statutory responsibility
of the State Government except in the Union Territory of Delhi where the ESIC has taken
over direct responsibility to administer the same with effect from 1.4.1962. The
Corporation has also taken the responsibility of directly administering the existing
Occupational Disease Centres at Delhi. Mumbai, Calcutta, Chennai and Nagda as well as
the Scheme in the Industrial pocket of Uttar Pradesh i.e., Noida and Greater Noida.




                                                                                          22
Domiciliary Treatment



An Insured Person and his family members are entitled to free medical attendance by
IMO/IMP at their residence when the condition of the patient is such that he/she cannot
reasonably 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 and
Recording".




                                                                                     23
Specialists Consultation



The standard of Medical Care under the E.S.I. Scheme provides for specialist consultation
to 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 at
Specialist/Diagnostic Centres, E.S.I. Hospitals or at such other institutions by appointing
Specialists/Super Specialists on full time/part-time basis where suitable arrangements
exist. 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. Anaesthesiology


It 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 each
diagnostic Centre and emergency centres as far as possible. The other specialities may be
provided as per disease profile of the area/as per requirement.




                                                                                        24
In-Patient treatment

Under 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 of
beds in the hospitals owned by the State Government, local Fund Organisation or Private
Bodies or by constructing annexes to such institutions. The E.S.I. Scheme pays for these
beds on the basis of occupied bed days. The Corporation has framed standard plans for
construction of different sizes of hospitals/annexes mainly with a view to achieving
uniformity and standardisation all over the country.

The Corporation has also laid down norms for equipment and staff for hospitals of
different bed strengths.

Drugs and Dressings

Under 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 of
beds in the hospitals owned by the State Government, local Fund Organisation or Private
Bodies or by constructing annexes to such institutions. The E.S.I. Scheme pays for these
beds on the basis of occupied bed days. The Corporation has framed standard plans for
construction of different sizes of hospitals/annexes mainly with a view to achieving
uniformity and standardisation all over the country.

The Corporation has also laid down norms for equipment and staff for hospitals of
different bed strengths.




Drugs and Dressings

All drugs and dressings (including vaccines and sera) that may be considered necessary
and 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) hospital

Part II:- List of medicines to be supplied by dispensaries in Service Areas or by approved
chemists or depots on prescription in panel areas.




                                                                                        25
Imaging Services



Imaging Services and Laboratory Investigations

Imaging and investigations including CT Scan, MRI, Echocardiography and laboratory
facilities are provided free of cost to IPs and their families at state level speciality
hospitals or other institutions having tie up with E.S.I. Scheme.




Artificial Limbs & Aids



Artificial Limbs, Aids, and Appliances

Insured Persons and their family members are provided following artificial limbs, aids and
appliances 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 of
expenditure on medical care.




                                                                                       26
Reimbursement

Under Regulation 69, every employer has to arrange for First-aid Medical care and
transport of accident cases till the injured IP is seen by the IMO/IMP and such employer is
entitled to reimbursement of expenses incurred in this regard upto the maximum of scale
prescribed from time to time. However, reimbursement is not permissible, if the
employer is required to provide such medical aid free of charge under any other
enactment.

The cost of provision of such emergency treatment would be reimbursed to the employer
by the Director/AMO (ESI Scheme) of the respective State and, therefore, all claims duly
supported by relevant receipts and vouchers should be sent to him for verification and
payment.

Reimbursement of expenses incurred in respect of medical treatment under
regulation-96                            A.

Regulation-96 A reads as follows:- Claims for reimbursement of expenses incurred in
respect of medical treatment of IP and his family may be accepted in circumstances and
subject 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 the
cases 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
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
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 Charges

In the absence of availability of an ambulance and where needed in an emergency, any
other quick form of transport may be used and amount so spent subject to the maximum
rate 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 medical
institution for admission, specialist consultation or investigation, but whose condition is
not such as to need an ambulance, provision has been made for the payment of
conveyance charges, if hospital/medical institution to which the case is referred to, is at
an out-station or is at a distance of more than 8 kms from the ESI Dispensary or the clinic
of the panel doctor. The charges are restricted to actual IInd class railway fare or cost of
a 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 be
recorded and so certified by IMO/IMP, the conveyance charges are also allowed for an
escort.

The IMO/IMP should keep a separate account of such payments in the prescribed Register
and send a quarterly statement of this expenditure to the Director/AMO by the 15 th of
the month following the quarter ending in March, June, Sept. and December. The returns
received from different areas in the State may be consolidated area-wise by the
Director/ 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 the
usual ratio within ceiling prescribed.




                                                                                         29
Forms
Form01      :   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 Form
Form1B      :   Changes in Family Declaration Form
Form3       :   Return of Declaration Forms
Form4       :   Identity Card
Form4(A)        Family Identity Card
Form5           Return of Contributions
Form7           FIRST/INTERMEDIATE/FINAL CERTIFICATE
Form8           SPECIAL INTERMEDIATE CERTIFICATE
                Abstention verification in r/o Sickness Benefit/Temporary
Form10
                Disablement Benefit/MB
Form12          Sickness of Temporary Disablement Benefit
Form12A         Maternity Benefit for Sickness
Form13          Sickness or Temporary disablement or maternity benefit for sickness
Form13A         Maternity benefit for sickness
Form14          Sickness or temporary disablement or maternity benefit for sickness
Form14A         Maternity Benefit for Sickness
Form16          Accident report from employer
Form17          Dependant's or funeral benefit (Death Certificate)
Form18          Dependant's Benefit (Claim Form)
Form18A         Dependant's 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 Benefit
Form23          Maternity Benefit (Certificate of confinement or miscarriage)
Form24          Maternity Benefit (Notice of work)
Form25          Claim for Permanent Disablement Benefit
Form26          Certificate for permanent disablement benefit
Form27          Declaration and certificate for depenant's benefit




                                                                                      30
What is Registration?


Registration is the process by which every employer/factory and its every employee
employed for wages, is identified for the purpose of the Scheme, and their individual
records are set up for them.

The first step in the process is the obtaining of particulars about each coverable
factory/shop/establishment, and its identification by allotment of a number i.e. Code
No. by the R. O. so as to facilitate keep track of contributions payable/paid and the
connected obligations of the employers. Subsequent step is the registration of employees
of covered factories by the R. O/L. O. (where the work of registration of employees is
decentralised), 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 insured
employee may be entitled under the Scheme according to eligibility. Individual record of
each employer/employee will facilitate necessary changes in future from time to time
and proper watch for obtaining compliance from the employers and benefits to
concerned insured persons.

Registration of Employers

1.2 Section 2A of the ESI Act states as under:-

2A. Registration of factories and establishments-Every factory or establishment to which
this Act applies shall be registered within such time and in such manner as may be
specified 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 the
first time and to which an Employers’ Code No. is not yet allotted, and the employer in
respect of a factory or an establishment to which the Act previously applied but has
ceased to apply for the time being, shall furnish to the appropriate R. O. not later than
15 days after the Act becomes applicable, as the case may be, to the factory or
establishment, a declaration of registration in writing in form 01(hereinafter referred to
as employers’ registration form).

(b) The employer shall be responsible for the correctness of all the particulars and
information required to be furnished on the employer’s registration form.

(c) The appropriate Regional Office may direct the employer who fails to comply with the
requirements of paragraph (a) of this regulation within the time stated therein, to
furnish to that office employer’s registration form duly completed within such further
time as may be specified and such employer shall, thereupon, comply with the
instructions issued by that office in this behalf.



                                                                                       31
(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 has
already been allotted an employer’s code number) and shall inform the employer of that
number.

(e) The employer shall enter the employer’s code number on all documents prepared or
completed by him in connection with the Act, the rules and these regulations and in all
correspondence with the appropriate office.

EMPLOYERS CAN NOW SUBMIT APPLICATION ONLINE FOR REGISTRATION UNDER ESI
ACT




                                                                                       32
Mumbai Facts and Figures

Civic Statistics (2005-2006)          City           W.Subs             E.subs            Total
Total No. of Properties                  64032            121228            77295           262555
Rateable Value of all the
                                         529.26           871.85          2985.75          1699.86
Properties
Rate of R.V. per Head                  1590.88           1784.28            807.15         4182.32
Total Length of Roads in Kms             506.46           927.65            507.05         1941.16
Fire Stations                                  15             12                   6               33
Private Markets                                11              4                   1               16
Municipal Markets                              43             65                  30              138
Mumbai Census Population

Year                                                     Population
1961                                                                                      41,52,056
1971                                                                                      59,70,575
1981                                                                                      82,43,405
1991                                                                                      99,25,891

Mumbai 2001, 2004, 2005 & 2006 **

Population 2001 Census                                              =                   1,19,78,450
MidYear Estimated Population 2004                                   =                   1,26,61,952
MidYear Estimated Population 2005                                   =                   1,28,67,208
MidYear Estimated Population 2006                                   =                   1,30,72,464



Year                                            2001          2004           2005             2006
Number of Births                             1,88,417      1,85,729       1,84,171         1,79,861
Crude Birth Rate (@ 1000
                                               15.72          14.67          14.31           13.76
Population)
Number of Deaths                              85,051         86,433         87,128          90,113
Crude Death Rate (@ 1000
                                                 7.10          6.83               6.8          6.89
Population)
Number of Infant Deaths                        7,255          6,505          6,469             6,21
Infant Mortality Rate (@1000 Birth)              38.5         35.02          35.12           34.57
Neo Natal Deaths                               4,392          3,981          3,924           3,922
Neo-Natal Death Rate (@1000
                                                 23.3          21.4              21.3          21.8
Births)
Number of Maternal Deaths                           16             50             82              114
Maternal Mortality Rate (@ 1000
                                                 0.08          0.27              0.44          0.63
Births)




                                                                                               33
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      Outdoor
1.ESIS               550     12,000       15,500         64       161
Hospital,Worli



2.ESIS               650     18,000       40,000         80       193
Hospital,Andheri



3.ESIS               650     20,060      1,63,700        98       156
Hospital,Mulund



4.ESIS               300     1,800         2500          47        83
Hospital,Kandivli




                                                                        34
Data On The Working Of The ESIS Hospital, Mulund (W)



A.   Established in 1971
B.   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 & Club

C.   Kitchen – Ground floor
D.   OPD – Ground floor
E.   POD – Ground + 1
F.   Physiotherapy Building – Road Building ground
G.   World Band Building – Ground + 2
H.   Nurses Hostel – Ground + 2
I.   Medical Council – Ground + 2
J.   Store Building – Ground
K.   Dhobi Ghat – Ground
L.   School Building – Ground
M.   Mortuary – Ground
N.   Dustbin – Ground




                                                                 35
Total Area Covered




                                                        Area
Type         Building   Levels       Quarters
                                                        Sq ft
I            7          Ground + 3   7 x 4 x 12 = 336   172

II           7          Ground + 3   7 x 4 x 4 = 112    375

III          2          Ground + 3   2 x 4 x 4 = 32     6111

IV           3          Ground + 3   3 x 4 x 2 = 24     940

V            2          Ground + 3   2 x 4 x 2 = 16     1211

VI           1          Ground + 3   1x4x2=8            1700

Total Area                                              10,509




                                                                 36
Staff Position Of ESI Hospital, Mulund




                            Position of the post of the Staff




              Cadre             Sanctioned post           Filled   Vacant


Class I                                  18                 10       8


Class II                                 33                 28       6


Class III                                59                 43      16


Class IV                                 329               307      22


Sister Incharge                          20                 9       11


Staff Nurse                              120               108      12


Paramedical                              42                 37       5




                                                                         37
Beds Distribution Of The ESIS Hospital, Mulund (W)


Total Sanctioned Beds                                400

Medical                                              104

Pediatrics                                           40

General Surgery                                      96

Orthopedic                                           38

Obst & Gynaecology                                   72

Ophtalmic                                            20

ENT                                                  20

ICCU                                                  5

Casualty                                              5




                                                           38
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
Statement Showing OPD Attendance Of ESI Hospital, Mulund




DEPARTMENTS                     2005-06         2006-07    2007-08
Medical                           19,926          18,946   20,151
Surgery                           7,733           9,144     8,789
Gynaecology                       9,902           9,132     7,458
Orthopeadic                       10,843          14,069   17,743
Peadiatric                        3,065           2,850     2,063
Ophthalmic                        4,005           3,812     3,527
ENT                               3,250           3,549     3,262
Skin                              5,146           5,194     2,252
ICCU                              4,591           4,371     1,839
TB                                6,865           5,727     5,356




                                                               40
Statement Showing OPD Attendance Of ESI Hospital, Mulund




                Outbound      Service Accident             Total   Per day
2005-06             82016        21046    13526             116588       392
2006-07             78793        18432    11375             108600       362
2007-08             73714        17576    12842             104132       347




Statement 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
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
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 WORLI
03-OVERTIME ALLOWANCES        NAKA, MUMBAI              1      16430.449        1                  0        0                 0

06-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.AUNDH
14-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
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
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
From the Kitchen

Diet chart of ESI Hospital, Mulund




                                     46
Food served at ESI Hospital, Mulund




                                      47
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
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 expenses


Special 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
Present Initiatives in working of ESIC
The profiles of the Employees’ State Insurance Corporation are being changed towards
greater accessibility and client satisfaction.

The Employees State Insurance Scheme provides need based social security benefits to
insured workers in the organized sector. ESIC has taken up the daunting task of tailoring
different benefit schemes for the needs of different worker groups. The scheme, which
was 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 about
310. 54 lakh beneficiaries including the family workers of the insured persons, across the
country. The scheme is being gradually to cover new centers and steps are being taken
for creation of requisite infrastructure for providing medical care to a larger number of
insured persons and their families. While the cash benefits under the scheme are
administered through a network of about 850 local offices and pay offices, medical care
is provided through 141 ESI Hospitals, 43 ESI Annexes, 1451 ESI Dispensaries and 2789
Clinics of Insurance Medical Practitioners. The total number of medical officers under
the 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 new
employees 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 from
payment of their share of contribution. Earlier this limit was Rs. 25/-. This measure has
benefited about six lakh insured workers across the country. In order to provide relief to
insured persons suffering from chronic and long term diseases, the list of diseases for
which Sickness Benefit is available for an extended period up to two years at an
enhanced rate of 70% of daily wages, was enlarged by adding four new diseases, keeping
in view the international classification of disease profiles and the quantum of
malignancies of some diseases which had come to light over the last few years. The
contributory conditions for this benefit were also reduced from 183 days to 156 days in
the 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 for
setting up of Model hospital. Two Hospitals have been earmarked for being developed for
superspeciality medical care in cardiology, i.e., Rohini at Delhi and Chinchwad in
Maharashtra.

In order to improve the standard of medical care in the States, the amount reimbursable
to the State Governments for running the medical care scheme has been increased to
87.5 % of Rs. 700 per capita with effect from 1.4.2003. The ESIC has formulated action
plans for improving medical services under the ESI scheme with focus on modernization
of hospitals by upgrading their emergency and diagnostic facilities, development of
departments as per disease profiles, waste management, provision of intensive care
services, revamping of grievance handling services, continuing education programme,
computerization and upgradation of laboratories etc. The action plans have been in
operation since 1998. The ESIC has also taken certain new initiatives to promote and
popularize Indian Systems of Medicines (ISM) along with Yoga and have drawn up


                                                                                       50
programmes for establishing these facilities in ESI hospitals and dispensaries in a phased
manner.

Social security to the workers in the organized sector

Social Security to the workers in the Organized Sector is provided through five Central
Acts, namely, the ESI Act, the EPF & MP Act, the Workmens’ Compensation Act, the
Maternity Benefit Act, and the Payment of Gratuity Act. In addition, there are a large
number of welfare funds for certain specified segments of workers such as beedi
workers, cine workers, construction workers etc.




                                                                                       51
Overview Of Healthcare Services In India


Healthcare Services

Public institutions played a dominant role in the Indian Healthcare sector in the past, in
the urban as well as in the rural areas. However, the public healthcare has been on a
serious decline during the last two or three decades because of non-availability of
medical and paramedical staff, diagnostic services and medicines. Consequently there
has been a pronounced decline in the percentage of cases of hospitalized treatment in
Government hospitals and a corresponding increase in the percentage treated in private
hospitals, despite higher costs in the private sector.

The Group is of the view that it is imperative for the health and safety of the population
to enforce minimum standards on clinical establishments in both the private and public
sectors by laying down minimum standards and enforcing them rigorously. The Clinical
Establishments (Registration and Regulation) Bill, 2007 having been introduced in the
Parliament it would important to ensure that it becomes law at the earliest and that it
enters into force for all the States. The next step would be for the proposed National
Committee to set appropriate standards for all categories of clinical establishments.

Implementation of the minimum standards will only be the initial step for improving the
quality of healthcare institutions in the country. The next step for improving their quality
should be for all stakeholders to advocate that these institutions take advantage of the
accreditation system already established in the country. It would be important for the
Central and State Governments to take steps to enable the clinical establishments in the
public sector also to avail of the accreditation system.

National Commission for Enterprises in the Unorganised Sector (NCEUS) proposed health
insurance scheme for BPL families to cover the entire BPL population of 30 crore (5 crore
families) in five years time. The High Level Group recommended that the Health
Insurance Programme for BPL categories be implemented at the earliest.

The overriding requirement in the country is for increasing the supply of human resources
at all levels, from specialists to paramedical personnel and to improve their quality. The
Group is of the view that the only way to accomplish this is for the medical education
sector to be opened up completely for private sector participation and companies to be
allowed to establish medical and dental colleges just as they have been allowed to open
nursing colleges. Other entry barriers such as the requirement of land and built up space
need also to be lowered to realistic levels in order to facilitate the opening up of new
colleges. Government’s role should be limited to opening a few high quality institutions
dedicated to research.

In order to improve the quality of education in Government medical colleges it is
necessary to give incentive to the teaching faculty. Wherever possible they should be
allowed to undertake private practice and in other cases granted handsome non-
practicing allowance.




                                                                                         52
The establishment of the regulatory Paramedical Council is crucial for expansion of
training facilities and for improvement of the training programme in respect of
paramedical personnel and the High Level Group expressed the hope that the law will be
enacted shortly. In addition Government should encourage private players, including
large hospitals and hospital chains, to undertake training programmes under the
regulatory control of the Paramedics Council. A development council for taking wider
initiatives for the training of paramedical personnel could also be considered.

The High Level Group is of the view that the qualifications of doctors and radiologists
who have been trained in the UK or other foreign countries should be recognized by the
Indian Medical Council on an exceptional basis in order to increase the pool of quality
medical personnel available to the Indian service providers and increase their
competitiveness in providing service for medical value travel, telemedicine as well as
clinical research.

The Group considers the shortage of trained personnel to be the biggest challenge for
improving the country’s competitiveness in the field of clinical research. The Group
recommends the establishment of a Clinical and Medical Research Council with the
participation of the private sector for formulating, promoting and running training
programmes for the area.

The Drugs Controllers office needs to be suitably strengthened and manned with
personnel (including guest personnel from abroad) who are equipped with knowledge of
the latest advances in medical research. A world class testing laboratory should be set up
in the country in the PPP mode, where the Central Governments gives assistance for
construction of building and purchase of equipment but the management is undertaken
by the private sector. Arrangement needs to be made for accreditation of CROs for the
purpose of certifying their adherence to Guidelines for Good Clinical Practices.




                                                                                       53
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 death
rates to 8.7. One of the recent projections made on the basis of Population Foundation of
India data is given below in table 2 indicating key demographic changes till 2021. The
disparities 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       5
Andhra Pradesh      19.4        14      7.6       7.4     63.8/66.7 69.6/73.4
Karnataka           21.6       14.9     7.9       7.1     63.8/67.1 69.3/72.6
Kerala              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       72.5/74.9
Tamil 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       5
Madhya Pradesh      28.7       21.4    11.7       8.3     57.9/57.8 65.7/65.8
Orissa              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       6
Uttar Pradesh       31.7       28.4    10.9        7      61.3/60.0 69.3/69.8


At this stage, a process understanding of longevity and child health may be useful for
understanding progress in future. Longevity, always a key national goal, is not merely the
reduction of deaths as a result of better medical and rehabilitative care at old age. In
fact without reasonable quality of life in the extended years marked by self-confidence
and 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 based
acceptance 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 run
across life lived at all ages in reduction of mortality among infants through immunization
and nutrition interventions and reduction of mortality among young and middle aged
adults, including adolescents getting informed about sexuality reproduction and safe
motherhood. At the same time, some segments will remain always more vulnerable
– such as women (due to patriarchy and traditions of intra-family denial), aged (whose
percentage will increase dramatically with improved health care), children (whose
survival 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 from
infection as in ensuring nutrition and calls for a holistic view of mother and child health
services. The cluster of services consisting of antenatal services, delivery care and post
partum attention and low birth weight, childhood diarrhea and ARI management are
linked priorities. Programs of immunization and childhood nutrition seen in better



                                                                                        54
performing states indicate sustained attention to routine and complex investments into
growing children as a group to make them grow into persons capable of living long and
well. Often interest fades in pursuing the unglamorous routine of supervised
immunisation and is substituted by pulse campaigns etc. which in the long run turn out
counter-productive. Indeed persistence with improved routines and care for quality in
immunisation would also be a path way to reduce the world’s highest rate of maternal
mortality In this context we may refer to the large ratio-based rural health infrastructure
consisting of over 5 lakh trained doctors working under plural systems of medicine and a
vast frontline force of over 7 lakh ANMs, MPWs and Anaganwadi workers besides
community volunteers. The creation of such public work force should be seen as a major
achievement in a country short of resources and struggling with great disparities in
health status. As part of rural Primary health care network alone, a total of 1.36 lakh
subcenters, (with 1.27 lakh ANMs in position) and 22975 PHCs and 2935 CHCs (with over
24000 doctors and over 3500 specialists to serve in them) have been set up. .To promote
Indian systems of medicine and homeopathy there are over 22000 dispensaries 2800
hospitals Besides 6 lakh angawadis serve nutrition needs of nearly 20 million children and
4 million others. The total effort has cost the bulk of the health development outlay
which stood at over Rs 62 500/- crores or 3.64 % of total plan spending during the last
fifty years.

On any count these are extraordinary infrastructural capacities created with resources
committed against odds to strengthen grass roots. There have been facility gaps, supply
gaps and staffing gaps, which can be filled up only by allocating about 20% more funds
and determined will to ensure good administration and synergy from greater congruence
of services, but given the sheer size of the endeavor there will always be some failure of
commitment and in routine functioning. These get exacerbated by periodic campaign
mode and vertical programs, which have only increased compartmentalized vision and
over-medicalization of health problems the initial key mistake arose from the needless
bifurcation of health and family welfare and nutrition functions at all levels instead of
promoting more holism. As a result of all this the structure has been precluded from
reaching its optimal potential. It has got more firmly established at the periphery /sub-
center level and dedicated to RCH services only. At PHC and CHC levels this has further
been compounded by a weak referral system. There has not been enough convergence in
“escorting” children through immunization coverage and nutrition education of mothers
and ensuring better food to children, including cooked midday meals and health checks
at schools. There has also been no constructive engagement between allopathic and
indigenous systems to build synergies, which could have improved people’s perceptions
of benefits from the infrastructure in ways that made sense to them.

One key task in the coming decades is therefore to utilize fully that created potential by
attending to well known organizational motivational and financial gaps. The gaps have
arisen partly from the source and scale of funds and partly due to lack of persistence,
both of which can be set right. PHCs and CHCs are funded by States several of whom are
unable to match Central assistance offered and hence
these centers remain inadequate and operate on minimum efficiency. On the other hand
over two thirds cost of three fourths of sub-centers are fully met by the Center due to
their key role in family welfare services. But in equal part these gaps are due to many
other non-monetary factors such as undue centralization and uniformity, fluctuating
commitment to key routines at ground level, insufficient experimentation with
alternatives such as getting public duties discharged through private professionals and
ensuring greater local accountability to users.


                                                                                        55
Project esis hospital
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Project esis hospital

  • 2. Acknowledgement..............................................................4 Objectives Of The Study:.....................................................5 Employee State Insurance Corporation....................................6 ESI Scheme.......................................................................8 Corporation.................................................................................8 Constitution of Corporation.............................................................9 Statement...................................................................................9 Coverage 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?....................................................................31 Mumbai Facts and Figures..................................................33 Data of the ESIS Hospitals in Mumbai.....................................34 Data On The Working Of The ESIS Hospital, Mulund (W).............35 Total Area Covered......................................................................36 Staff Position Of ESI Hospital, Mulund ...............................................37 2
  • 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........................45 From the Kitchen.............................................................46 Diet chart of ESI Hospital, Mulund...................................................46 Our Recommendations to the above problems........................49 Special Initiatives.............................................................49 Present Initiatives in working of ESIC....................................50 Overview Of Healthcare Services In India...............................52 Healthcare Services.....................................................................52 Public Health System....................................................................56 Initiatives on Public Health Infrastructure in the XI Plan........................57 Challenges before the healthcare sector in India......................58 Regulation.................................................................................58 Licensing...................................................................................59 ..............................................................................................60 Skill Deficit in Healthcare .................................................61 Indian Medical Professionals in Foreign Countries.....................62 Health Education.........................................................................63 Limited Coverage of Health Insurance...............................................64 Responding To Challenges..................................................65 Regulation of clinical establishments and improving the quality of healthcare institutions................................................................................65 Expanding Health Insurance ...........................................................65 Medical Education .......................................................................66 Concern: .......................................................................68 Dead-end:......................................................................70 Report Of The National Commission On Macroeconomics And Health ....................................................................................71 Analysis of effects made for evolving standards and developing an accreditation system.........................................................73 Ministry Level Infrastructure ..............................................76 Regional Level Infrastructure..............................................77 Regional Level Infrastructure..............................................78 ESI Hospitals In Mumbai......................................................79 ESI Branch Offices In Mumbai Region (Maharashtra)..................80 Member Of Employees's State Insurance Corporation................85 Photo Gallery .................................................................89 3
  • 4. Acknowledgement At the outset, it is my duty to acknowledge with `gratitude the generous help that I received from all the offices and individuals towards completion of this project. It was for their proactive support that a survey work of this magnitude could be completed. Special thanks to the entire ESIS team under the guidance of Mr Acharya , AO and to Mr Gunje in particular. It was for their unending support that the project team could finish its report on time. Our heartfelt appreciation also goes to Mr Jandhlekar, Kitchen In- charge and Ms Mudras, Dietician providing timely information to the project team. Dr. W A Dalvi, RMO deserves special mention for the support received from him 4
  • 5. Objectives Of The Study: The Employees' State Insurance Corporation (ESIC) of India is one of the largest social security organizations providing medical insurance cover and delivering of medical care to 35 million beneficiaries through 140 hospitals and 1500 dispensaries. The objectives of this study are to understand the working system of ESI hospital and suggest systems for e-governance to facilitate the coordination 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 in practice for offering medical benefits to the insured persons and their beneficiaries. This working paper brings out our detailed analysis of the working of ESI hospital, Mulund in delivering medical care under the ESI scheme. 5
  • 6. Employee State Insurance Corporation The Employees' State Insurance Act (ESI Act), promulgated by the Indian Parliament in 1948, provides a comprehensive social security for workers in the lower wage bracket. The ESI Act applies to non-seasonal, power using factories or manufacturing units employing ten or more persons and non-power using establishments employing twenty or more 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 the purview of the Act. Employees of the aforesaid categories of factories and establishments, but drawing wages only up to Rs.6500/- a month, are entitled to health insurance cover under the ESI Act. The wage ceiling for purpose of coverage is revised from 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 industrial units at Kanpur and Delhi. Over the last four and a half decades, ESIS has emerged as the largest multidimensional social security set up in Southeast Asia. As of now, the ESI Act is applicable to over 250,000 industrial units in the country, benefiting about 87 lakhs family units of workers in the lower wage bracket, accounting for a total beneficiary population of about 330 lakhs. ESIS guarantees full medical facilities to the beneficiaries and adequate cash compensation to insured persons. Medical benefit comprises outpatient care, domiciliary visits, specialist and diagnostic services, hospitalization, super specialist treatment, free supply of drugs, dressings, artificial aids and appliances, besides immunization and family welfare service, etc. Cash benefits include benefits payable in cash on account of loss of wages or earning capacity caused by sickness, temporary disablement, occupational disease, maternity or death or permanent disablement of an insured person due to employment injury or an occupational disease. ESIS is a self-financing health insurance scheme. Contributions are raised from covered employees and their employers as a fixed percentage of wages. Covered employees contribute 1.75% of the wages, whereas, the employers contribute 4.75% of the wages of the covered employees. Contributions are the same irrespective of the nature of employment 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 by employees and employers are deposited in a common pool known as the ESI Fund. ESI fund is utilized for meeting the administrative expenses of the ESI scheme, as well as the cash and medical benefits to the insured persons and their dependants ESIS is administered by a corporate body called Employees' State Insurance Corporation (ESIC). The Union Minister of Labour heads the corporation as its Chairman. Its members include representatives from the employers, employees, the central and state governments, medical professionals and members of the parliament. Certain important statistics of ESIC are given in Exhibit 1. Revenue receipts and expenditure of ESIC for the year 1999- 2000 are given in Exhibit 2. 6
  • 7. ESIC has set up a large number of hospitals, dispensaries, and diagnostic centres across the country for delivering primary, outpatient, and inpatient healthcare services. ESIC is one of the few organizations wherein the concept of 'a proper referral system' is adhered to. Those seeking medical attention under the scheme are required to first consult their doctor at the designated dispensaries. The doctors at the dispensaries would if required refer the patients for indoor treatment. Patients, who are advised to undergo indoor treatment, have the option to choose any ESI hospital or an ESI approved hospital according to their preferences, except in the case of super specialty treatment which are available under the scheme only at a few designated hospitals. Clinical investigation services, outpatient and inpatient treatments, as well all the prescribed medicines and drugs 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. The expenditure incurred on provision of medical benefit is shared by the corporation and the state governments in the ratio of 7:1 within the prescribed per capita ceiling on expenditure. From 1-4-99, ESIC has fixed the ceiling of expenditure for medical facilities per insured person family unit at Rs. 600. This ceiling of Rs. 600 is further divided into the following four categories of expenditure: • A maximum of Rs. 170 per Insured Person (IP) family unit per annum for drugs and dressings • A maximum of Rs. 20 per IP family unit per annum for maintenance and repair of medical equipments • A maximum of Rs. 50 per IP family unit per annum for expenditure to be incurred towards reimbursement of super specialty services not available in ESI institutions, • A maximum of Rs. 360 per IP family unit per annum towards salaries and administrative expenses. Amount spent by a State Government (on medical benefits) beyond this per capita limit is borne by the State Government itself. A comparison of medical benefits across all the states and union territories is given in Exhibit 3. 7
  • 8. ESI Scheme Employees’ State Insurance Scheme of India is an integrated social security scheme tailored to provide social protection to workers and their dependants, in the organised sector, in contingencies, such as, sickness, maternity and death or disablement due to an employment injury or occupational hazard. The ESI Act, (1948) applies to following categories of factories and establishments in the implemented 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 of the ESI Act to various classes of establishments, industrial, commercial or agricultural or otherwise. Under these enabling provisions most of the State Govts have extended the ESI Act to certain specific class of establishments, such as, shops, hotels, restaurants, cinemas, preview theatres, motors transport undertakings and newspaper establishments etc., employing 20 or more persons. The ESI Scheme is mainly financed by contributions raised from employees covered under the scheme and their employers, as a fixed percentage of wages. Employees of covered units and establishments drawing wages upto Rs.10,000/- per month come under the purview of the scheme for social security benefits. However, employees’ earning upto Rs.50/- a day as wages are exempted from payment of their part of contribution. The State Govts bear one-eighth share of expenditure on Medical Benefit within the per capita ceiling of Rs.900/- per annum and all additional expenditure beyond the ceiling. Employees covered under the scheme are entitled to medical facilities for self and dependants. They are also entitled to cash benefits in the event of specified contingencies resulting in loss of wages or earning capacity. The insured women are entitled to maternity benefit for confinement. Where death of an insured employee occurs due to employment injury, the dependants are entitled to family pension Corporation The Employees’ State Insurance Scheme is administered by a corporate body called the ESI Corporation. The Corporation is the highest policy making and decision taking authority under the ESI Act and oversees the functioning of the Scheme. The Corporation meets periodically to conduct business as may be required to regulate the functioning of the Scheme. 8
  • 9. Constitution of Corporation This apex body is constituted and notified by the Central Government for a four year term and represents various interest groups comprising employees, employers, the Central and State Governments besides the parliament and medical profession. Union Minister of Labour functions as the Chairman of the Corporation whereas, Director General ESIC, is also an ex-officio member of the Corporation. Statement To provide for certain benefits to Employees in case of sickness, maternity and employment injury and to make provisions for related matters. 9
  • 10. Coverage Under The ESI Act, 1948 The Act was originally applicable to non-seasonal factories using power and employing 20 or more persons; but it is now applicable to non-seasonal power using factories employing 10 or more persons and non-power using factories employing 20 or more persons. Under Section 1(5) of the Act, the Scheme has been extended to shops, hotels, restaurants, cinemas including preview theatre, road motor transport undertakings and newspaper establishment employing 20 or more persons. The existing wage-limit for coverage under the Act, is Rs.10,000/- per month (with effect from 1.10.2006). Areas Covered The ESI Scheme is being implemented area-wise by stages. The Scheme has already been implemented in different areas in the following States/Union Territories States All the States except Nagaland, Manipur, Tripura, Sikkim, Arunachal Pradesh and Mizoram. Union Territories Delhi, Chandigarh and Pondicherry Coverage : 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. Finance The Scheme is mainly financed by contributions from employers and employees. The employers’ contribution is equal to four and three fourth per cent of the wages payable to employees. The employees’ contribution is at the rate of one and three-fourth per cent of the wages payable to an employee. The State Governments share expenditure on the 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. Contribution E.S.I. Scheme being contributory in nature, all the employees in the factories or establishments 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 of employer’s contribution and employee’s contribution at a specified rate. The rates are revised from time to time. Currently, the employee’s contribution rate (w.e.f. 1.1.97) is 1.75% of the wages and that of employer’s is 4.75% of the wages paid/payable in respect of the employees in every wage period. Employees in receipt of a daily average wage upto Rs.50/- are exempted from payment of contribution. Employers will however contribute their own share in respect of these employees. Collection of Contribution An employer is liable to pay his contribution in respect of every employee and deduct employees contribution from wages bill and shall pay these contributions at the above specified rates to the Corporation within 21 days of the last day of the Calendar month in which the contributions fall due. The Corporation has authorized designated branches of the State Bank of India and some other banks to receive the payments on its behalf. Contribution Period and Benefit Period There are two contribution periods each of six months duration and two corresponding benefit periods also of six months duration as under. Contribution period Corresponding Cash Benefit period 1st 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. Benefits The 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 Expenses An interesting feature of the ESI Scheme is that the contributions are related to the paying capacity as a fixed percentage of the workers wages, whereas, they are provided social security benefits according to individual needs without distinction. Cash Benefits are disbursed by the Corporation through its Local Offices LOs/ Mini Local Offices (MLOs)/Sub Local Offices SLOs)/pay offices, subject to certain contributory conditions. In addition, the scheme also provides some other need based benefits to insured workers. These includes : i. Rehabilitation allowance ii. Vocational Rehabilitation iii. Unemployment Allowance (Under Rajiv Gandhi Shramik Kalyan Yojana) 13
  • 14. Type Of Medical Benefits Provided The Employees’ State Insurance Scheme provides full medical care in the form of medical attendance, treatment, drugs and injections, specialist consultation and hospitalization to insured persons and also to members of their families where the facility for Specialist consultation, hospitalization has been extended to the families. For the families, this benefit has been divided into two categories as under:- Full Medical Care This consists of hospitalization facilities and includes specialist services, drugs and dressings and diets as required for in-patients. Expanded Medical Care This consists of consultation with the specialists and supply of special medicines and drugs as may be prescribed by them in addition to the out-patient care. This also includes facilities for special laboratory tests and X-Ray examinations. Apart from the curative services provided through hospitals and dispensaries, the Corporation also provides the following facilities including family welfare services. Immunization The Corporation has embarked upon a massive programme of immunization of young children of insured persons. Under this programme, preventive inoculation and vaccines are given against diseases like diphtheria, pertusis, polio, tetanus, measles, mumps, rubella, tuberculosis etc. Family Welfare Services Along with the immunization programme, the Corporation has been undertaking provision of family Welfare Services to the beneficiaries of the Scheme. The Corporation has organized these services in 180 centres besides reserving 330 beds in hospitals for undertaking tubectomy operations. So far, 828976 sterilization operation viz. 176197 vasectomies and 652779 tubectomies have been performed upto 31.3.1999. The ESI Corporation has also extended additional cash incentive to insured persons to promote acceptance of sterilization method by providing sickness cash benefit equal to full wage for a period of 7 days for vasectomy and 14 days for tubectomy. The period for which cash benefit is admissible is extended beyond the above limits in the event of any complications after Family Planning operations. 14
  • 15. Supply Of Special Aids Insured 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 Benefits Sickness Benefit represents periodical cash payments made to an IP during the period of certified sickness occurring in a benefit period when IP requires medical treatment and attendance 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 daily wages 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 less than 78 days during the corresponding contribution period. (ii)A person who has entered into insurable employment for the first time has to wait for nearly 9 months before becoming eligible to sickness benefit, because his corresponding benefit period starts only after that interval. (iii)Sickness Benefit is not payable for the first two days of a spell of sickness except in case of a spell commencing within 15 days of closure of earlier spell for which sickness benefit was last paid. This period of 2 days is called "waiting period". This provision should be clearly understood by IMOs/IMPs as actual experience shows that such of IPs who want to avail medical leave on flimsy grounds generally come for First Certificate/First & Final Certificate within 15 days of earlier spell, usually on unpaid holidays and/or on each weekly off etc, to avoid loss of benefit for 2 days due to fresh waiting period. Sickness Benefits Extended Sickness Benefit Enhanced Sickness Benefit 15
  • 16. Extended Sickness Benefit IPs suffering from long term diseases were experiencing great hardship on expiry of 91 days 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 Sickness Benefit)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 exhausting Sickness Benefit to which he may be eligible. A common list of these long term diseases for which ESB is payable, is reviewed by the Corporation from time to time. The list was last reviewed on 5.12.99 and revised provisions of ESB became effective from 1.1.2000 and at present this list includes 34 diseases which are grouped in 11 groups as per International Classification of diseases and theo names of many existing diseases have been 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. 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. Dementia XI Others 32. More than 20% burns with infection/complication 33. Chronic Renal Failure 34. Reynaud’s disease/Burger’s disease. 17
  • 18. 1. In addition to the above list, Director General/Medical Commissioner are authorised to sanction ESB for a maximum period upto 730 in cases of rare but treatable diseases or under special circumstances, such as, adverse reaction to drugs which have not been included in the above list, depending on the merits of each case, on the recommendations of RDMC/AMO or either authorised officers runniong the medical scheme. 2. To be entitled to the Extended Sickness Benefit an Insured Persons should have been in continuous employment for 2 years or more at the beginning of a spell of sickness in which 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 309 days in chronic suitable cases by Regional Dy. Medical Commissioner/Medical Referee/Administrative Medical Officer/Chief Executive of the E.S.I. Scheme in the State or his nominee on the report of the specialist(s). Enhanced Sickness Benefits It 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 enhanced sickness benefit at double the rate of sickness benefit i.e., about full average daily wage for undergoing sterilisation operations for family welfare. Duration of enhanced Sickness Benefits is upto 7 days in the case of Vasectomy and upto 14 days in the case of the Tubectomy from the date of operation or from the date of admission in the hospital as the case may be. The period is extendable in case of post operative complications. 18
  • 19. Maternity Benefits Maternity Benefit is payable to an Insured Woman in the following cases subject to contributory conditions:- Confinement-payable for a period of 12 weeks (84 days) on production of Form 21 and 23. 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 not exceeding 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 a child, 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 the average daily wage. Temporary disablement Benefit (TDB) (a) TDB is payable to an employee who suffers employment injury (EI) or Occupational Disease and is certified to be temporarily incapable to work. "Employment Injury" has been defined under Section 2(8) of the Act, as a personal injury to an employee caused by 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 disease is 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. (d) Duration of TDB : There is no prescribed limit for the duration of TDB. This is payable as long as temporary disablement lasts and significant improvement by treatment is possible. If a Temporary Disablement spell lasts for less than 3 days (excluding day of accident), IP will be paid sickness benefit, if otherwise eligible. A special point for IMOs/IMPs is that some IPs may resist 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 read with provision of 6(A) of Section 2 in cases where an IP dies as result of EI. The age of dependants, has to be determined either by production of Documentary evidence as specified in Regulation 80(2) or Age 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 are increased from time to time. The latest enhancement is with effect from 01.08.2002 System of Treatment Generally, the allopathic system of medicine is used for providing Medical Benefit. However, where a substantial number of workers demand treatment by Indian system of medicine and Homoeopathy (ISM & H) other than Allopathy and where the State Government has recognised the qualifications in such system, treatment facilities may be provided under the ISM & H as well. The various ISM &H systems of treatment in vogue are:, Ayurvedic, Unani, Sidha, Yoga therapy and Homeopathy. Certificates required for the purpose of Cash Benefits in respect of persons treated by ISM &H should be issued by IMO /IMP having recognised qualifications in such system and duly appointed by the State Government. The issue of certificates under ISM &H is possible only where dispensaries in systems other than allopathic medicine are functioning independently with IPs and their family units attached to them and not functioning merely as referral units. In places where ISM &H units function only as referral centres, certificates will have to be issued by the Allopathic dispensary to which the IP is attached. 20
  • 21. Scale of Medical Benefit The scale of Medical Benefit under section 57 of Act to be provided to the IPs and members of their families is to be prescribed by State Government in consultation with the Corporation under Section 58(1 & 3) of Act under State Medical Benefit Rules. An IP and/or a member of his family does not have the right to claim Medical Services over and above those which have been so prescribed. The beneficiaries are entitled to reasonable medical, 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 members in all implemented areas as the rates of the contribution paid by the employees and the employers are the same throughout the country. 21
  • 22. Benefits to Retired IPs Medical 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 be provided (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 State The administration of Medical Benefit under the ESI Scheme is the statutory responsibility of the State Government except in the Union Territory of Delhi where the ESIC has taken over direct responsibility to administer the same with effect from 1.4.1962. The Corporation has also taken the responsibility of directly administering the existing Occupational Disease Centres at Delhi. Mumbai, Calcutta, Chennai and Nagda as well as the Scheme in the Industrial pocket of Uttar Pradesh i.e., Noida and Greater Noida. 22
  • 23. Domiciliary Treatment An Insured Person and his family members are entitled to free medical attendance by IMO/IMP at their residence when the condition of the patient is such that he/she cannot reasonably 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 and Recording". 23
  • 24. Specialists Consultation The standard of Medical Care under the E.S.I. Scheme provides for specialist consultation to 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 at Specialist/Diagnostic Centres, E.S.I. Hospitals or at such other institutions by appointing Specialists/Super Specialists on full time/part-time basis where suitable arrangements exist. 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. Anaesthesiology It 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 each diagnostic Centre and emergency centres as far as possible. The other specialities may be provided as per disease profile of the area/as per requirement. 24
  • 25. In-Patient treatment Under 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 of beds in the hospitals owned by the State Government, local Fund Organisation or Private Bodies or by constructing annexes to such institutions. The E.S.I. Scheme pays for these beds on the basis of occupied bed days. The Corporation has framed standard plans for construction of different sizes of hospitals/annexes mainly with a view to achieving uniformity and standardisation all over the country. The Corporation has also laid down norms for equipment and staff for hospitals of different bed strengths. Drugs and Dressings Under 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 of beds in the hospitals owned by the State Government, local Fund Organisation or Private Bodies or by constructing annexes to such institutions. The E.S.I. Scheme pays for these beds on the basis of occupied bed days. The Corporation has framed standard plans for construction of different sizes of hospitals/annexes mainly with a view to achieving uniformity and standardisation all over the country. The Corporation has also laid down norms for equipment and staff for hospitals of different bed strengths. Drugs and Dressings All drugs and dressings (including vaccines and sera) that may be considered necessary and 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) hospital Part II:- List of medicines to be supplied by dispensaries in Service Areas or by approved chemists or depots on prescription in panel areas. 25
  • 26. Imaging Services Imaging Services and Laboratory Investigations Imaging and investigations including CT Scan, MRI, Echocardiography and laboratory facilities are provided free of cost to IPs and their families at state level speciality hospitals or other institutions having tie up with E.S.I. Scheme. Artificial Limbs & Aids Artificial Limbs, Aids, and Appliances Insured Persons and their family members are provided following artificial limbs, aids and appliances 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 of expenditure on medical care. 26
  • 27. Reimbursement Under Regulation 69, every employer has to arrange for First-aid Medical care and transport of accident cases till the injured IP is seen by the IMO/IMP and such employer is entitled to reimbursement of expenses incurred in this regard upto the maximum of scale prescribed from time to time. However, reimbursement is not permissible, if the employer is required to provide such medical aid free of charge under any other enactment. The cost of provision of such emergency treatment would be reimbursed to the employer by the Director/AMO (ESI Scheme) of the respective State and, therefore, all claims duly supported by relevant receipts and vouchers should be sent to him for verification and payment. Reimbursement of expenses incurred in respect of medical treatment under regulation-96 A. Regulation-96 A reads as follows:- Claims for reimbursement of expenses incurred in respect of medical treatment of IP and his family may be accepted in circumstances and subject 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 the cases 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. 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. 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 Charges In the absence of availability of an ambulance and where needed in an emergency, any other quick form of transport may be used and amount so spent subject to the maximum rate 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 medical institution for admission, specialist consultation or investigation, but whose condition is not such as to need an ambulance, provision has been made for the payment of conveyance charges, if hospital/medical institution to which the case is referred to, is at an out-station or is at a distance of more than 8 kms from the ESI Dispensary or the clinic of the panel doctor. The charges are restricted to actual IInd class railway fare or cost of a 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 be recorded and so certified by IMO/IMP, the conveyance charges are also allowed for an escort. The IMO/IMP should keep a separate account of such payments in the prescribed Register and send a quarterly statement of this expenditure to the Director/AMO by the 15 th of the month following the quarter ending in March, June, Sept. and December. The returns received from different areas in the State may be consolidated area-wise by the Director/ 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 the usual ratio within ceiling prescribed. 29
  • 30. Forms Form01 : 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 Form Form1B : Changes in Family Declaration Form Form3 : Return of Declaration Forms Form4 : Identity Card Form4(A) Family Identity Card Form5 Return of Contributions Form7 FIRST/INTERMEDIATE/FINAL CERTIFICATE Form8 SPECIAL INTERMEDIATE CERTIFICATE Abstention verification in r/o Sickness Benefit/Temporary Form10 Disablement Benefit/MB Form12 Sickness of Temporary Disablement Benefit Form12A Maternity Benefit for Sickness Form13 Sickness or Temporary disablement or maternity benefit for sickness Form13A Maternity benefit for sickness Form14 Sickness or temporary disablement or maternity benefit for sickness Form14A Maternity Benefit for Sickness Form16 Accident report from employer Form17 Dependant's or funeral benefit (Death Certificate) Form18 Dependant's Benefit (Claim Form) Form18A Dependant's 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 Benefit Form23 Maternity Benefit (Certificate of confinement or miscarriage) Form24 Maternity Benefit (Notice of work) Form25 Claim for Permanent Disablement Benefit Form26 Certificate for permanent disablement benefit Form27 Declaration and certificate for depenant's benefit 30
  • 31. What is Registration? Registration is the process by which every employer/factory and its every employee employed for wages, is identified for the purpose of the Scheme, and their individual records are set up for them. The first step in the process is the obtaining of particulars about each coverable factory/shop/establishment, and its identification by allotment of a number i.e. Code No. by the R. O. so as to facilitate keep track of contributions payable/paid and the connected obligations of the employers. Subsequent step is the registration of employees of covered factories by the R. O/L. O. (where the work of registration of employees is decentralised), 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 insured employee may be entitled under the Scheme according to eligibility. Individual record of each employer/employee will facilitate necessary changes in future from time to time and proper watch for obtaining compliance from the employers and benefits to concerned insured persons. Registration of Employers 1.2 Section 2A of the ESI Act states as under:- 2A. Registration of factories and establishments-Every factory or establishment to which this Act applies shall be registered within such time and in such manner as may be specified 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 the first time and to which an Employers’ Code No. is not yet allotted, and the employer in respect of a factory or an establishment to which the Act previously applied but has ceased to apply for the time being, shall furnish to the appropriate R. O. not later than 15 days after the Act becomes applicable, as the case may be, to the factory or establishment, a declaration of registration in writing in form 01(hereinafter referred to as employers’ registration form). (b) The employer shall be responsible for the correctness of all the particulars and information required to be furnished on the employer’s registration form. (c) The appropriate Regional Office may direct the employer who fails to comply with the requirements of paragraph (a) of this regulation within the time stated therein, to furnish to that office employer’s registration form duly completed within such further time as may be specified and such employer shall, thereupon, comply with the instructions issued by that office in this behalf. 31
  • 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 has already been allotted an employer’s code number) and shall inform the employer of that number. (e) The employer shall enter the employer’s code number on all documents prepared or completed by him in connection with the Act, the rules and these regulations and in all correspondence with the appropriate office. EMPLOYERS CAN NOW SUBMIT APPLICATION ONLINE FOR REGISTRATION UNDER ESI ACT 32
  • 33. Mumbai Facts and Figures Civic Statistics (2005-2006) City W.Subs E.subs Total Total No. of Properties 64032 121228 77295 262555 Rateable Value of all the 529.26 871.85 2985.75 1699.86 Properties Rate of R.V. per Head 1590.88 1784.28 807.15 4182.32 Total Length of Roads in Kms 506.46 927.65 507.05 1941.16 Fire Stations 15 12 6 33 Private Markets 11 4 1 16 Municipal Markets 43 65 30 138 Mumbai Census Population Year Population 1961 41,52,056 1971 59,70,575 1981 82,43,405 1991 99,25,891 Mumbai 2001, 2004, 2005 & 2006 ** Population 2001 Census = 1,19,78,450 MidYear Estimated Population 2004 = 1,26,61,952 MidYear Estimated Population 2005 = 1,28,67,208 MidYear Estimated Population 2006 = 1,30,72,464 Year 2001 2004 2005 2006 Number of Births 1,88,417 1,85,729 1,84,171 1,79,861 Crude Birth Rate (@ 1000 15.72 14.67 14.31 13.76 Population) Number of Deaths 85,051 86,433 87,128 90,113 Crude Death Rate (@ 1000 7.10 6.83 6.8 6.89 Population) Number of Infant Deaths 7,255 6,505 6,469 6,21 Infant Mortality Rate (@1000 Birth) 38.5 35.02 35.12 34.57 Neo Natal Deaths 4,392 3,981 3,924 3,922 Neo-Natal Death Rate (@1000 23.3 21.4 21.3 21.8 Births) Number of Maternal Deaths 16 50 82 114 Maternal Mortality Rate (@ 1000 0.08 0.27 0.44 0.63 Births) 33
  • 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 Outdoor 1.ESIS 550 12,000 15,500 64 161 Hospital,Worli 2.ESIS 650 18,000 40,000 80 193 Hospital,Andheri 3.ESIS 650 20,060 1,63,700 98 156 Hospital,Mulund 4.ESIS 300 1,800 2500 47 83 Hospital,Kandivli 34
  • 35. Data On The Working Of The ESIS Hospital, Mulund (W) A. Established in 1971 B. 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 & Club C. Kitchen – Ground floor D. OPD – Ground floor E. POD – Ground + 1 F. Physiotherapy Building – Road Building ground G. World Band Building – Ground + 2 H. Nurses Hostel – Ground + 2 I. Medical Council – Ground + 2 J. Store Building – Ground K. Dhobi Ghat – Ground L. School Building – Ground M. Mortuary – Ground N. Dustbin – Ground 35
  • 36. Total Area Covered Area Type Building Levels Quarters Sq ft I 7 Ground + 3 7 x 4 x 12 = 336 172 II 7 Ground + 3 7 x 4 x 4 = 112 375 III 2 Ground + 3 2 x 4 x 4 = 32 6111 IV 3 Ground + 3 3 x 4 x 2 = 24 940 V 2 Ground + 3 2 x 4 x 2 = 16 1211 VI 1 Ground + 3 1x4x2=8 1700 Total Area 10,509 36
  • 37. Staff Position Of ESI Hospital, Mulund Position of the post of the Staff Cadre Sanctioned post Filled Vacant Class I 18 10 8 Class II 33 28 6 Class III 59 43 16 Class IV 329 307 22 Sister Incharge 20 9 11 Staff Nurse 120 108 12 Paramedical 42 37 5 37
  • 38. Beds Distribution Of The ESIS Hospital, Mulund (W) Total Sanctioned Beds 400 Medical 104 Pediatrics 40 General Surgery 96 Orthopedic 38 Obst & Gynaecology 72 Ophtalmic 20 ENT 20 ICCU 5 Casualty 5 38
  • 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. Statement Showing OPD Attendance Of ESI Hospital, Mulund DEPARTMENTS 2005-06 2006-07 2007-08 Medical 19,926 18,946 20,151 Surgery 7,733 9,144 8,789 Gynaecology 9,902 9,132 7,458 Orthopeadic 10,843 14,069 17,743 Peadiatric 3,065 2,850 2,063 Ophthalmic 4,005 3,812 3,527 ENT 3,250 3,549 3,262 Skin 5,146 5,194 2,252 ICCU 4,591 4,371 1,839 TB 6,865 5,727 5,356 40
  • 41. Statement Showing OPD Attendance Of ESI Hospital, Mulund Outbound Service Accident Total Per day 2005-06 82016 21046 13526 116588 392 2006-07 78793 18432 11375 108600 362 2007-08 73714 17576 12842 104132 347 Statement 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. 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. 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 WORLI 03-OVERTIME ALLOWANCES NAKA, MUMBAI 1 16430.449 1 0 0 0 06-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.AUNDH 14-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. 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. 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. From the Kitchen Diet chart of ESI Hospital, Mulund 46
  • 47. Food served at ESI Hospital, Mulund 47
  • 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. 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 expenses Special 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. Present Initiatives in working of ESIC The profiles of the Employees’ State Insurance Corporation are being changed towards greater accessibility and client satisfaction. The Employees State Insurance Scheme provides need based social security benefits to insured workers in the organized sector. ESIC has taken up the daunting task of tailoring different benefit schemes for the needs of different worker groups. The scheme, which was 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 about 310. 54 lakh beneficiaries including the family workers of the insured persons, across the country. The scheme is being gradually to cover new centers and steps are being taken for creation of requisite infrastructure for providing medical care to a larger number of insured persons and their families. While the cash benefits under the scheme are administered through a network of about 850 local offices and pay offices, medical care is provided through 141 ESI Hospitals, 43 ESI Annexes, 1451 ESI Dispensaries and 2789 Clinics of Insurance Medical Practitioners. The total number of medical officers under the 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 new employees 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 from payment of their share of contribution. Earlier this limit was Rs. 25/-. This measure has benefited about six lakh insured workers across the country. In order to provide relief to insured persons suffering from chronic and long term diseases, the list of diseases for which Sickness Benefit is available for an extended period up to two years at an enhanced rate of 70% of daily wages, was enlarged by adding four new diseases, keeping in view the international classification of disease profiles and the quantum of malignancies of some diseases which had come to light over the last few years. The contributory conditions for this benefit were also reduced from 183 days to 156 days in the 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 for setting up of Model hospital. Two Hospitals have been earmarked for being developed for superspeciality medical care in cardiology, i.e., Rohini at Delhi and Chinchwad in Maharashtra. In order to improve the standard of medical care in the States, the amount reimbursable to the State Governments for running the medical care scheme has been increased to 87.5 % of Rs. 700 per capita with effect from 1.4.2003. The ESIC has formulated action plans for improving medical services under the ESI scheme with focus on modernization of hospitals by upgrading their emergency and diagnostic facilities, development of departments as per disease profiles, waste management, provision of intensive care services, revamping of grievance handling services, continuing education programme, computerization and upgradation of laboratories etc. The action plans have been in operation since 1998. The ESIC has also taken certain new initiatives to promote and popularize Indian Systems of Medicines (ISM) along with Yoga and have drawn up 50
  • 51. programmes for establishing these facilities in ESI hospitals and dispensaries in a phased manner. Social security to the workers in the organized sector Social Security to the workers in the Organized Sector is provided through five Central Acts, namely, the ESI Act, the EPF & MP Act, the Workmens’ Compensation Act, the Maternity Benefit Act, and the Payment of Gratuity Act. In addition, there are a large number of welfare funds for certain specified segments of workers such as beedi workers, cine workers, construction workers etc. 51
  • 52. Overview Of Healthcare Services In India Healthcare Services Public institutions played a dominant role in the Indian Healthcare sector in the past, in the urban as well as in the rural areas. However, the public healthcare has been on a serious decline during the last two or three decades because of non-availability of medical and paramedical staff, diagnostic services and medicines. Consequently there has been a pronounced decline in the percentage of cases of hospitalized treatment in Government hospitals and a corresponding increase in the percentage treated in private hospitals, despite higher costs in the private sector. The Group is of the view that it is imperative for the health and safety of the population to enforce minimum standards on clinical establishments in both the private and public sectors by laying down minimum standards and enforcing them rigorously. The Clinical Establishments (Registration and Regulation) Bill, 2007 having been introduced in the Parliament it would important to ensure that it becomes law at the earliest and that it enters into force for all the States. The next step would be for the proposed National Committee to set appropriate standards for all categories of clinical establishments. Implementation of the minimum standards will only be the initial step for improving the quality of healthcare institutions in the country. The next step for improving their quality should be for all stakeholders to advocate that these institutions take advantage of the accreditation system already established in the country. It would be important for the Central and State Governments to take steps to enable the clinical establishments in the public sector also to avail of the accreditation system. National Commission for Enterprises in the Unorganised Sector (NCEUS) proposed health insurance scheme for BPL families to cover the entire BPL population of 30 crore (5 crore families) in five years time. The High Level Group recommended that the Health Insurance Programme for BPL categories be implemented at the earliest. The overriding requirement in the country is for increasing the supply of human resources at all levels, from specialists to paramedical personnel and to improve their quality. The Group is of the view that the only way to accomplish this is for the medical education sector to be opened up completely for private sector participation and companies to be allowed to establish medical and dental colleges just as they have been allowed to open nursing colleges. Other entry barriers such as the requirement of land and built up space need also to be lowered to realistic levels in order to facilitate the opening up of new colleges. Government’s role should be limited to opening a few high quality institutions dedicated to research. In order to improve the quality of education in Government medical colleges it is necessary to give incentive to the teaching faculty. Wherever possible they should be allowed to undertake private practice and in other cases granted handsome non- practicing allowance. 52
  • 53. The establishment of the regulatory Paramedical Council is crucial for expansion of training facilities and for improvement of the training programme in respect of paramedical personnel and the High Level Group expressed the hope that the law will be enacted shortly. In addition Government should encourage private players, including large hospitals and hospital chains, to undertake training programmes under the regulatory control of the Paramedics Council. A development council for taking wider initiatives for the training of paramedical personnel could also be considered. The High Level Group is of the view that the qualifications of doctors and radiologists who have been trained in the UK or other foreign countries should be recognized by the Indian Medical Council on an exceptional basis in order to increase the pool of quality medical personnel available to the Indian service providers and increase their competitiveness in providing service for medical value travel, telemedicine as well as clinical research. The Group considers the shortage of trained personnel to be the biggest challenge for improving the country’s competitiveness in the field of clinical research. The Group recommends the establishment of a Clinical and Medical Research Council with the participation of the private sector for formulating, promoting and running training programmes for the area. The Drugs Controllers office needs to be suitably strengthened and manned with personnel (including guest personnel from abroad) who are equipped with knowledge of the latest advances in medical research. A world class testing laboratory should be set up in the country in the PPP mode, where the Central Governments gives assistance for construction of building and purchase of equipment but the management is undertaken by the private sector. Arrangement needs to be made for accreditation of CROs for the purpose of certifying their adherence to Guidelines for Good Clinical Practices. 53
  • 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 death rates to 8.7. One of the recent projections made on the basis of Population Foundation of India data is given below in table 2 indicating key demographic changes till 2021. The disparities 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 5 Andhra Pradesh 19.4 14 7.6 7.4 63.8/66.7 69.6/73.4 Karnataka 21.6 14.9 7.9 7.1 63.8/67.1 69.3/72.6 Kerala 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 72.5/74.9 Tamil 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 5 Madhya Pradesh 28.7 21.4 11.7 8.3 57.9/57.8 65.7/65.8 Orissa 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 6 Uttar Pradesh 31.7 28.4 10.9 7 61.3/60.0 69.3/69.8 At this stage, a process understanding of longevity and child health may be useful for understanding progress in future. Longevity, always a key national goal, is not merely the reduction of deaths as a result of better medical and rehabilitative care at old age. In fact without reasonable quality of life in the extended years marked by self-confidence and 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 based acceptance 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 run across life lived at all ages in reduction of mortality among infants through immunization and nutrition interventions and reduction of mortality among young and middle aged adults, including adolescents getting informed about sexuality reproduction and safe motherhood. At the same time, some segments will remain always more vulnerable – such as women (due to patriarchy and traditions of intra-family denial), aged (whose percentage will increase dramatically with improved health care), children (whose survival 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 from infection as in ensuring nutrition and calls for a holistic view of mother and child health services. The cluster of services consisting of antenatal services, delivery care and post partum attention and low birth weight, childhood diarrhea and ARI management are linked priorities. Programs of immunization and childhood nutrition seen in better 54
  • 55. performing states indicate sustained attention to routine and complex investments into growing children as a group to make them grow into persons capable of living long and well. Often interest fades in pursuing the unglamorous routine of supervised immunisation and is substituted by pulse campaigns etc. which in the long run turn out counter-productive. Indeed persistence with improved routines and care for quality in immunisation would also be a path way to reduce the world’s highest rate of maternal mortality In this context we may refer to the large ratio-based rural health infrastructure consisting of over 5 lakh trained doctors working under plural systems of medicine and a vast frontline force of over 7 lakh ANMs, MPWs and Anaganwadi workers besides community volunteers. The creation of such public work force should be seen as a major achievement in a country short of resources and struggling with great disparities in health status. As part of rural Primary health care network alone, a total of 1.36 lakh subcenters, (with 1.27 lakh ANMs in position) and 22975 PHCs and 2935 CHCs (with over 24000 doctors and over 3500 specialists to serve in them) have been set up. .To promote Indian systems of medicine and homeopathy there are over 22000 dispensaries 2800 hospitals Besides 6 lakh angawadis serve nutrition needs of nearly 20 million children and 4 million others. The total effort has cost the bulk of the health development outlay which stood at over Rs 62 500/- crores or 3.64 % of total plan spending during the last fifty years. On any count these are extraordinary infrastructural capacities created with resources committed against odds to strengthen grass roots. There have been facility gaps, supply gaps and staffing gaps, which can be filled up only by allocating about 20% more funds and determined will to ensure good administration and synergy from greater congruence of services, but given the sheer size of the endeavor there will always be some failure of commitment and in routine functioning. These get exacerbated by periodic campaign mode and vertical programs, which have only increased compartmentalized vision and over-medicalization of health problems the initial key mistake arose from the needless bifurcation of health and family welfare and nutrition functions at all levels instead of promoting more holism. As a result of all this the structure has been precluded from reaching its optimal potential. It has got more firmly established at the periphery /sub- center level and dedicated to RCH services only. At PHC and CHC levels this has further been compounded by a weak referral system. There has not been enough convergence in “escorting” children through immunization coverage and nutrition education of mothers and ensuring better food to children, including cooked midday meals and health checks at schools. There has also been no constructive engagement between allopathic and indigenous systems to build synergies, which could have improved people’s perceptions of benefits from the infrastructure in ways that made sense to them. One key task in the coming decades is therefore to utilize fully that created potential by attending to well known organizational motivational and financial gaps. The gaps have arisen partly from the source and scale of funds and partly due to lack of persistence, both of which can be set right. PHCs and CHCs are funded by States several of whom are unable to match Central assistance offered and hence these centers remain inadequate and operate on minimum efficiency. On the other hand over two thirds cost of three fourths of sub-centers are fully met by the Center due to their key role in family welfare services. But in equal part these gaps are due to many other non-monetary factors such as undue centralization and uniformity, fluctuating commitment to key routines at ground level, insufficient experimentation with alternatives such as getting public duties discharged through private professionals and ensuring greater local accountability to users. 55