The much-vaunted Universal Health Insurance Scheme of the Central Govt is said to be facing rough weather, with very few private insurance companies and Third Party Administrators joining in.
The scheme launched one month back envisages a premium of Rs 1 to Rs 2 per day to be paid by people who cannot afford the full premium. This would entitle them to insurance cover of upto Rs 30,000 for hospital expenses.
According to informed sources, though the scheme has started garnering some participants from around the country, the Centre is perturbed about the fact that there aren't enough service providers to take this scheme to the remote and inaccessible areas.
According to official figures, for the 90 different regional centres in the country there are only 23 Third Party Administrators who are registered to service them. "The Centre is said to have sent a circular to several Third Party Administrators and private players seeking active co-operation from them in making this scheme a success", said S K Mahapatra, secretary, General Insurance Public Sector Association, which is responsible for implementing the scheme.
While so far only six TPA's have managed to respond to the call from the Centre, others are still to follow suit, noted Mahapatra. "It is easy to float a scheme but implementation is an arduous task. We are still in the preparatory stage for ramping the facilities and being a group policy it would involve co-operation from other local bodies including the NGO's. Hence, we are appealing for more participation from private and local bodies in making this scheme reachable to all", said Mahapatra.
Addressing a solution to the problem Mahapatra noted, leaving aside the 6-7 TPA's who are concentrated heavily in the urban areas, the other 15-16 of those who are duly registered by the IRDA could concentrate more on the outreach into rural and far away areas.
Says he, "Options should be given to the TPA's to create their own set-up, so that those with less numbers could take up the cause to service the masses in these remote areas. Also with hospitals and primary centres being scarce in these areas it would be difficult to stringently implement this scheme whose basic aim is to make available healthcare services to the less-deprived section of the society", he noted.
But Mahapatra is quick to assure that with proper networking and involvement of more independent bodies, the scheme could be a success. According to him, at the time of the launch of the scheme, it has been stated that the scheme will be administered on a group approach comprising co-operative societies, vocational groups and self-help groups involved in micro-finance activity. These target groups would be further addressed through NGO's or local bodies like panchayats and zila parishads.
"These intermediaries have been promised compensation at the rate of 10 per cent of the premium income. Hence, we are positive of more TPA's joining in to aid the cause", he stated.
According to the scheme, hospitals run by NGOs, state government, trust hospitals, selected private hospitals with fixed schedule of charges will be enlisted for providing benefit; commission of 10 per cent to be allowed for procurement expenses and 5 per cent for claims services and members enrolled will be duly certified by the sponsoring agency.
Under the scheme, a premium equivalent to Rs 1/- per day (Rs 365 per year) for an individual, Rs 1.50/- for a day for a family of five and Rs 2/- day for a family of seven, will entitle eligibility to get reimbursement of medical expenses up to Rs 30,000 towards hospitalization, a cover for death due to accident for Rs 25,000 and compensation due to loss of earning at the rate of Rs 50/- per day upto maximum of 15 days. Further to make the scheme more affordable, the government would be contributing Rs 100/- per year towards the annual premium of those enlisted.