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