Syed Khaled Shah, Sagarm Sreedhar, RSV Badrinath and Rao Chelikani
A Model Community Pact with a Neighbouring Hospital by a Resident Welfare Association or a Senior Citizen Association
Why we need to act directly and immediately?
The following proposal
contains the benefits of family doctor and community doctor facilities and
better human relations in an institutional way which is being felt as essential
for the welfare of urban middle-class families. This is particularly needed in
a political context in which there is no clear national consensus to introduce
gradually a nationwide system or a network of institutionalized universal
social security for all. We have only piecemeal welfare schemes which are
annually budgeted by the governments. As a consequence, as estimated by the
Benguluru-based Narayana Health Hospitals, there are 40% of Indians and among
them, a higher percentage of urban residents are left out of the government
health insurance schemes like Ayushman Bharat. They have to take care of
themselves. In any case, health insurance in India is, at present understood to
cover only the expenses of serious disease treatment, rather than healthcare
and human welfare. At the same time, hospital expenses are becoming unbearable
for a middle-class family. Senior citizens are the first victims of this
situation, as traditional health insurance does not cover comprehensive care,
including day-to-day medical expenses and benign treatments. As huge amounts
are to be paid suddenly, families are getting indebted and impoverished. The
private health care and medical institutions and health professionals, though
predominant in the economy of this sector, they are not being recognised by the
state policies as the only ultimate solution for keeping good health for all
citizens. In times of emergencies like the one that we experienced at the time
of COVID-19, the local infrastructure and local healthcare professionals can
and would have volunteered to attend to issues in the area immediately at a low
cost, instead of outsiders. By authorizing only a very few hospitals, they were
highly discredited for having charged the one-time patients opportunistically.
Even during normal
times, at present, there are no channels for the private sector establishments
to express their Social Responsibility towards the local community in the area
among whom the hospitals are working and their professionals are living. On the
other hand, in some situations, some hospitals are, now and then, subjected to
blackmail, vandalism and forced contributions by rowdy elements. In such
situations, they need the intervention of the local community elders in the
RWAs.
At present, dealing
directly with health insurance companies, especially with the nationalized ones
is proving very bureaucratic, risky, litigious and frustrating. Usually,
middlemen like brokers or agents attached to them are mostly unskilled and not
legally responsible. The premiums are high, especially for the aged, while the
companies claim to be incurring losses due to management issues. The fact that
life insurance is thriving better than health insurance indicates that the old
mindset of insecurity is still persisting..
Under these
circumstances, it is always better for the urban residents that whatever they
spend for health purposes should be spent on the neighbouring health service
providers directly. It is a pact for mutual benefit and would create humane
relations. The local residents can ensure blood collection, organ donation and
humanitarian assistance to the patients. They might participate in medical
research. Grateful patients and NRIs might donate for additional facilities.
NRI doctors can show their Social Responsibility by participating in the
campaigns of the hospital of their areas of origin.
Inspired by the new
economic culture that is emerging in the country, hospitals and clinics can be
more transparent and accountable to society. The Patients Charter is one of
them. Further, we get the commitment from the hospitals that the discounts they
offer would be based on their chart of current tariffs that they are charging
in general to the general public. This is verifiable and comparable as the
charts would be made visible at the time of entering the MoU.
In future, the
healthcare professionals and the urban residents in RWAs together, would plead
with municipal, state and national governments to subsidise the expenses
incurred by the neighbouring hospitals on certain categories of persons who are
chosen by the governments for special benefits under their schemes, such as
Arogyadaan, etc. The merit of this model MoU is, the RWA or the SCA or both of
them together can solve or cover their health risks by negotiating mutually
acceptable terms in a contract with a neighbouring hospital. For a vast country
like India, governments cannot set up and run government hospitals accessible
everywhere and to all. The state should be content with, ultimately providing
platforms for direct dialogue and cooperation between the consumers and the
service-providers, and eventually subsidise some operations in the interests of
equity and social justice. Further, massive pension funds should be allowed to
invest in pharmaceutical and medical research and infrastructure. Since,
insurance is not a capital-intensive business but a matter of numbers, it
should be self-managed by all like RWAs, pensioners, hospitals, doctors,
nurses, medical shops, pharmaceutical firms, Testing laboratories, old age
homes and other service providers and scientists as cooperative shareholders.
The governments need to intervene, eventually to fill in the deficits, whenever
they occur with our tax money.
Suggested terms of the Memorandum of Agreement:
I. Membership Card as per the MoU: Rs. 1,000 (?) per head. Makes the RWA resident eligible for the following facilities: Minimum membership: 100 (?) cards.
1. Ambulance: Without putting the patient's life at risk and in a reasonable manner sending an Advanced Life Saving (ATS ) vehicle equipped with all the requisite articles, in the fastest manner possible. At 50% discount.
2. Pharmacy and Consumable items (MRP Items, etc.) utilized for care inside the ambulance and that the service shall be complimentary, or at a 50% discount.
3. Emergency Care on Priority: Assignment of a single point of contact number for all types of medical assistance.
4. Periodical Health, Nutrition Awareness Talks and Health Camps and observing the Doctors Day on 1st July, etc.
5. Health profile, case history and data of the analyses and tests carried out will be maintained, so as to minimize the diagnostic costs. As the relations would become familiar, there will be trust and confidence between the personnel and the patients.
6. Under certain conditions, telephonic consultations and counselling might be possible for senior citizens.
7. RWA will be termed as
"Preferred-Health Partner and Beneficiary Patient Treatment: as priority
patients (equivalent to patients with prior appointments), and shall provide
access to all specialisations available at the hospital as on that date, with
the following discounts:
i. Out Patient Consultation: Discount of 20% ii. Gerontological and geriatric counselling
at a 30% discount iii. Out Patient Diagnostic Discount of 15% on Blood
investigations and Radiology investigations, etc. iv. Complimentary Room
up-gradation up to the next level (as per room availability) v. Physiotherapy
facilities at a 50% discount vi. Annual Health Check Package: 30% discount vii.
Pharmacy and other consumables: 10% viii. Collateral and Promotions as and when
announced.
II. Family Membership card: Rs. 2,000 (?)
III. Privilege Card: Is offered with an entrance fee of Rs. 2,000 (?) per head annually. Minimum: 50 (?) cards.
In addition to the benefits offered to a membership cardholder, the P.C. holder would get:
1.4 Consultations Out-Patient.
2. Second consultation, in case the cardholder is under treatment with some other doctor.
3. Annual Health checkup: 50% discount.
4. Hospitalisation during the Day: 50% discount.
5. Domicile visits of the nurses: 50%.
6. Three Domicile visit of a generalist doctor: 25% .
7.Three Medical interventions, including benign surgeries, not involving major surgery, worth Rs.2,000/ each.
8. One visit of the Specialist doctor to another hospital to which the cardholder is referred, at a 30% discount.
9. In addition, the hospital will negotiate in advance a Critical Illness Policy with a cashless facility for all cardholders who would need it, with an insurance company, etc.
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