Employees’ State Insurance Corporation Health Security for All “ Challenges, Solution and Opportunities”

ESI SCHEME  ESI Scheme is an integrated social security scheme.  Central Govt. promulgated ESI Act 1948, to set up the ESI Corporation.  The Scheme was first implemented at Kanpur and Delhi in  The Scheme is administered by a corporate body called Employees State Insurance Corporation (ESIC). It comprises of members from Central, State Governments, Employers, Employees, Parliament and Medical profession  Director General is Ex officio/ CEO.  Union Minister of Labour as Chairman of ESIC.

COVERAGE  No. of I. P. Family units -2.03Cr.  No. of Beneficiaries(Total)-8.0 Cr.  No of Dispensaries 1459  No of ESI hospitals 151

CONTRIBUTION  ESI Scheme is mainly financed by contributions raised from employees covered under the scheme and their employers, the rates of contribution are:- (i) Employees Contribution : 1.75 % of wages (ii)Employers Contribution : 4.75 % of wages Employees earning up to Rs.100/- a day as wages are exempted from payment of their part of contribution.  Employees of covered units and establishments drawing wages up to Rs.15,000/- per month.

Contribution Income Year Contribution Income (in crore) Rs Rs Rs

SOCIAL SECURITY BENEFITS  Medical Benefit.  Sickness Benefit (Cash) a) Extended Sickness Benefit. b) Enhanced Sickness Benefit.  Maternity Benefit.  Disablement Benefit.  Dependent's Benefit.  Other Benefits: Funeral Expansés, Rehabilitation, Unemployment Allowance etc.

Challenges Delivery of services in the States run ESI Hospitals and Dispensaries. State Govt. not taking initiatives to provide quality health services to the patients. To improve quality of health services in State ESI Scheme Recruitment and selection of the medical manpower particularly in remote areas. High attrition rate of Skilled manpower.

Solutions  Finances not a problem  Availability of large infrastructure.  Under PPP mode, services are delivered in- house.  SST services which are not available in-house are delivered through tie-up arrangements.  ESIC run medical colleges to impart medical education to fulfill social responsibility – medical colleges-5+1, dental – 1, nursing - 1

Solutions (Contd)  IT enabled delivery of services ie HMIS, ERP etc  NTA and ZTI for imparting in-service training.  Scheme implemented in 31 states/UT  In rest of places, by

Solutions (Contd) ESIC 2.0 Reforms In-house lab & x-ray services in dispensaries. The remuneration to Insurance Medical Practitionerfor delivery of primary medical care increased from Rs 300/- to 500/-. The dispensaries are to be upgraded to 6 and 30 bedded hospitals in phased manner. Setting up of 24 x 7 helpline for beneficiaries. Setting up of AYUSH services in all hospitals and dispensaries. In- service training of the Medical and Para- medical. Electronic Health record to the patients.

Solutions (Contd) ESIC 2.0 Reforms Implementation of VIBGYOR pattern i.e. colored bed sheets in hospitals. Special OPDs in the afternoon for senior citizens and differently abled persons. To start Cardiology and Cancer treatment facility at different level of hospitals. To provide in-house Cath Lab, dialysis facilities in all ESIC Hospitals under PPP Model. Tele-medicine facility for beneficiaries in phases. AYUSH facility to be extended in all Hospital

Solutions (Contd) Empowering States Setting up of State ESI Corporation/ Society in all the States. State Executive Committee to monitor the Scheme in the State. Strengthening Hospital Development Committee. Special assistance for poor performing States

Opportunities To extend facilities to  Organised sector – new areas  Unorganised sector – construction workers etc.  Auto rickshaw drivers – Delhi and Hyderabad  Takeover of DGLW hospitals and dispensaries – 13 hospitals and 292 dispensaries

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